Healthcare Provider Details

I. General information

NPI: 1811050149
Provider Name (Legal Business Name): MICHAEL CARTER WHITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11150 HIGHWAY 1
PT REYES STA CA
94956
US

IV. Provider business mailing address

PO BOX 240
PT REYES STA CA
94956
US

V. Phone/Fax

Practice location:
  • Phone: 415-663-1082
  • Fax: 415-663-9474
Mailing address:
  • Phone: 415-663-1082
  • Fax: 415-663-9474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC313340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: