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General NPI Number Information
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NPI Number | 1003092487
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Entity Type | Organization
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Legal Business Name | MARY T. WHITAKER, M.D., P.A.
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 3612 SHANTARA LN
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City | PLANO
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State | TX
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Zip | 75093-7621
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Country | US
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Telephone | 972-378-3153
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Fax | 972-378-3154
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Provider Business Mailing Address
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Address Line | PO BOX 118405
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City | CARROLLTON
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State | TX
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Zip | 75011-8405
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Country | US
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Telephone | 972-378-3153
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Fax | 972-378-3154
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. CAROL A HOOD
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Credential |
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Telephone | 972-378-3153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | H0930
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License Number State | TX
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