Individual
JOHN WILLIAM WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504
(928) 729-8000
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2667871204
UT
207Q00000X
Family Medicine Physician
DO1711
NV
207Q00000X
Family Medicine Physician
TL4235
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730228917
—
NV
05
—
D0234
—
UT
Enumeration date
02/05/2007
Last updated
05/05/2022
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