Individual
BRENT J WHITLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5757 N DIXIE HWY, OAKLAND PARK, FL 33334-4135
(954) 776-6000
Mailing address
PO BOX 551014, TAMPA, FL 33655-1014
(800) 476-8646
(919) 382-3210
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME67493
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080072358
RAILROAD MEDICARE
FL
01
—
26888
BCBS
FL
05
—
378096100
—
FL
Enumeration date
06/08/2005
Last updated
04/07/2021
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