Healthcare Provider Details

I. General information

NPI: 1447710710
Provider Name (Legal Business Name): DUSTIN LEE WHITAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 MOBILE INFIRMARY BLVD
MOBILE AL
36607-3510
US

IV. Provider business mailing address

168 MOBILE INFIRMARY BLVD
MOBILE AL
36607-3510
US

V. Phone/Fax

Practice location:
  • Phone: 251-433-1895
  • Fax: 251-433-1917
Mailing address:
  • Phone: 251-433-1895
  • Fax: 251-433-1917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number47955
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: