Individual
DAVID R WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
105 WALL ST, POTEAU, OK 74953-4433
(918) 635-3566
(918) 635-3309
Mailing address
PO BOX 1148, POTEAU, OK 74953-1148
(918) 635-3566
(918) 635-3309
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R113988
OK
367500000X
Certified Registered Nurse Anesthetist
R871679
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08277891
—
MS
05
—
200499820B
—
OK
01
—
9957742
AETNA
MS
01
—
P01009724
RAILROAD MEDICARE
MS
Enumeration date
07/12/2011
Last updated
09/17/2015
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