Healthcare Provider Details

I. General information

NPI: 1205992203
Provider Name (Legal Business Name): ROBERT N WHITAKER JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 JAKE ALEXANDER BLVD WEST SUITE 101
SALISBURY NC
28147
US

IV. Provider business mailing address

PO BOX 5116 330 JAKE ALEXANDER BLVD WEST SUITE 101
SALISBURY NC
28147
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 Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number9500766
License Number StateNC

VIII. Authorized Official

Name: DR. ROBERT N WHITAKER JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 704-637-5668