Healthcare Provider Details

I. General information

NPI: 1073536322
Provider Name (Legal Business Name): WHITNEY DAVID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 WEIMER RD 600
TAOS NM
87571-6340
US

IV. Provider business mailing address

4221 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1103
US

V. Phone/Fax

Practice location:
  • Phone: 575-751-0334
  • Fax: 575-751-0297
Mailing address:
  • Phone: 505-717-1952
  • Fax: 505-433-4174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number28204
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD2006-0821
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: