Healthcare Provider Details

I. General information

NPI: 1669571659
Provider Name (Legal Business Name): DAVID W WHATMORE P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10103 RIDGEGATE PKWY #306
LONE TREE CO
80124-5520
US

IV. Provider business mailing address

10103 RIDGEGATE PKWY SUITE 306
LONE TREE CO
80124-5520
US

V. Phone/Fax

Practice location:
  • Phone: 303-225-8120
  • Fax: 303-225-8130
Mailing address:
  • Phone: 303-225-8120
  • Fax: 303-225-8130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number841375754
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: