Individual
WILLIE ROSCOE WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2117 SIMONTON RD, SUITE 102, STATESVILLE, NC 28625-8403
(704) 872-8422
(704) 872-8705
Mailing address
2117 SIMONTON RD, SUITE 102, STATESVILLE, NC 28625-8403
(704) 872-8422
(704) 872-8705
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
NC2003-00428
NC
207RN0300X
Nephrology Physician
Primary
2003-00428
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
134J6
BLUE CROSS BLUE SHIELD #
NC
01
—
3324386
CIGNA HEALTHCARE PROVIDER
NC
01
—
38354
PARTNERS' MEDICARE #
NC
05
—
89134J6
—
NC
01
—
C8620
MEDCOST
NC
01
—
E73961
UPIN
—
01
—
P00010140
RAILROAD MEDICARE
NC
Enumeration date
10/05/2005
Last updated
03/21/2014
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