Healthcare Provider Details

I. General information

NPI: 1417879719
Provider Name (Legal Business Name): TODD WHITEHURST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3013 W NORTH B ST
TAMPA FL
33609-2356
US

IV. Provider business mailing address

3013 W NORTH B ST
TAMPA FL
33609-2356
US

V. Phone/Fax

Practice location:
  • Phone: 323-999-1777
  • Fax:
Mailing address:
  • Phone: 323-999-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME18854
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: