Healthcare Provider Details

I. General information

NPI: 1003895582
Provider Name (Legal Business Name): JOY R WHIPPLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E MAIN ST STE 113
MIDWAY UT
84049-6828
US

IV. Provider business mailing address

210 E MAIN ST STE 113
MIDWAY UT
84049-6828
US

V. Phone/Fax

Practice location:
  • Phone: 435-657-1777
  • Fax: 435-657-0098
Mailing address:
  • Phone: 435-657-1777
  • Fax: 435-657-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number8866272
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number8866272
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: