Healthcare Provider Details

I. General information

NPI: 1639373129
Provider Name (Legal Business Name): WHITNEY LEIGH CHOUTEAU D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6750 N MACARTHUR BLVD SUITE 255
IRVING TX
75039-2875
US

IV. Provider business mailing address

5520 LBJ FWY STE 200
DALLAS TX
75240-6381
US

V. Phone/Fax

Practice location:
  • Phone: 972-823-3240
  • Fax: 972-823-3241
Mailing address:
  • Phone: 972-636-5727
  • Fax: 972-497-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberM5102
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: