Individual
A JEFFREY WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
47003
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34551500
—
WI
01
—
P00942387DB7792
RR MEDICARE
WI
01
—
WHITEJE4
MERCYCARE INSURANCE
WI
Enumeration date
02/24/2006
Last updated
09/10/2012
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