Individual
DR. BRUCE LEE WHITAKER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1350 WALTON WAY, AUGUSTA, GA 30901-2612
(706) 774-7745
(706) 774-5789
Mailing address
PO BOX 1705, AUGUSTA, GA 30903-1705
(706) 854-6008
(706) 774-7230
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101016483
MI
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
062124
LA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
5101016483
MI
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
OC-0415
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E00425
BLUE CROSS BLUE SHIELD
MI
05
—
1790923969
—
MI
Enumeration date
01/27/2009
Last updated
02/05/2024
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