Healthcare Provider Details

I. General information

NPI: 1528389947
Provider Name (Legal Business Name): SONJA MARTINA STEFANIE WHITAKER M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SONJA MARTINA STEFANIE UTHOFF M.D.,PH.D.

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13139 SORRENTO RD
PENSACOLA FL
32507-8777
US

IV. Provider business mailing address

PO BOX 2699 ATTN: SHMG/HPE
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-0020
  • Fax: 850-492-6340
Mailing address:
  • Phone: 850-416-0020
  • Fax: 850-492-6340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01072525A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME125279
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: