MEDICARE: JILL WHITEHURST M.D.

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	208000000X	Pediatrics Physician	0101244637	VA

General Provider Information

NPI Number	:	1891235206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL WHITEHURST M.D.

Provider Business Mailing Address
First Line	:	6436 GLENDORA AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-5125
Country	:	US
Telephone Number	:	202-489-4140
Fax Number	:

Provider Business Practice Location Address
First Line	:	6436 GLENDORA AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-5125
Country	:	US
Telephone Number	:	202-489-4140
Fax Number	:

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

Provider Enumeration Date	:	03/03/2017
Last Update Date	:	03/03/2017

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