MEDICARE: DR. JOE E WHITAKER 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	207R00000X	Internal Medicine Physician	ME59366	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00004389	OTHER	FL	UNITED
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	110178340	OTHER	FL	RAILROAD

General Provider Information

NPI Number	:	1881613859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOE E WHITAKER MD

Provider Business Mailing Address
First Line	:	4108 HENDERSON BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5750
Country	:	US
Telephone Number	:	813-289-4321
Fax Number	:	813-287-2949

Provider Business Practice Location Address
First Line	:	4108 HENDERSON BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5750
Country	:	US
Telephone Number	:	813-289-4321
Fax Number	:	813-287-2949

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	04/13/2015

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