Healthcare Provider Details

I. General information

NPI: 1548438179
Provider Name (Legal Business Name): DAVID VENABLE WHITMAN HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 N WESTERN AVE STE 108
OKLAHOMA CITY OK
73114-8016
US

IV. Provider business mailing address

12301 N WESTERN AVE STE 108
OKLAHOMA CITY OK
73114-8016
US

V. Phone/Fax

Practice location:
  • Phone: 405-962-8123
  • Fax:
Mailing address:
  • Phone: 405-962-8123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number800
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: