Healthcare Provider Details

I. General information

NPI: 1508809625
Provider Name (Legal Business Name): LEE CARL WHITAKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LEE C WHITAKER MD, MPH

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 9TH STREET
ST THOMAS VI
00802-0000
US

IV. Provider business mailing address

PO BOX 7425
ST THOMAS VI
00801-0425
US

V. Phone/Fax

Practice location:
  • Phone: 340-777-1996
  • Fax:
Mailing address:
  • Phone: 340-777-1996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD000035229
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number1625
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: