MEDICARE: BRENT J WHITLEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	ME67493	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080072358	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26888	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609870682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT J WHITLEY MD

Provider Business Mailing Address
First Line	:	PO BOX 551014
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33655-1014
Country	:	US
Telephone Number	:	800-476-8646
Fax Number	:	919-382-3210

Provider Business Practice Location Address
First Line	:	5757 N DIXIE HWY
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-4135
Country	:	US
Telephone Number	:	954-776-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	04/07/2021

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Directions to “ BRENT J WHITLEY MD” Practice Location

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