Individual
RICHARD A WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
SOCPAC SOJ07, BLD 20 RM 212, CAMP H M SMITH, HI 96861-4046
(808) 470-1082
Mailing address
SOCPAC SOJ07, BLD 20 RM 212, CAMP H M SMITH, HI 96861-4046
(808) 470-1082
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
1070457
GA
363AM0700X
Medical Physician Assistant
Primary
13217715-1206
UT
Other
Enumeration date
01/17/2006
Last updated
01/26/2023
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