Healthcare Provider Details

I. General information

NPI: 1134169816
Provider Name (Legal Business Name): BRETT D WHATCOTT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 MARKET TRCE
FORT SMITH AR
72908-8694
US

IV. Provider business mailing address

2707 MARKET TRACE
FORT SMITH AR
72908
US

V. Phone/Fax

Practice location:
  • Phone: 479-434-3600
  • Fax: 833-992-0797
Mailing address:
  • Phone: 479-434-3600
  • Fax: 479-434-3602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE2230
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number5515
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberE-2230
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberE2230
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: