Healthcare Provider Details

I. General information

NPI: 1255312898
Provider Name (Legal Business Name): ROBERT NORTON WHITAKER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 10/25/2020
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 JAKE ALEXANDER BLVD W SUITE 101
SALISBURY NC
28147-1384
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-637-5668
  • Fax: 704-637-5605
Mailing address:
  • Phone: 704-637-5668
  • Fax: 704-637-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number9500766
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: