Healthcare Provider Details

I. General information

NPI: 1235339342
Provider Name (Legal Business Name): BRENT BOOTH WHIDDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 N MCKENZIE ST
FOLEY AL
36535-2249
US

IV. Provider business mailing address

1725 N MCKENZIE ST
FOLEY AL
36535-2249
US

V. Phone/Fax

Practice location:
  • Phone: 251-943-2141
  • Fax: 251-949-3453
Mailing address:
  • Phone: 251-943-2141
  • Fax: 251-949-3453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD.30813
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: