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General NPI Number Information
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NPI Number | 1073606687
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Entity Type | Individual
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Provider Name | KENNETH A WHITTAKER MD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 506 N VILLA RD
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City | NEWBERG
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State | OR
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Zip | 97132-1833
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Country | US
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Telephone | 503-554-0036
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Fax | 503-538-9257
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Provider Business Mailing Address
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Address Line | 506 N VILLA RD
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City | NEWBERG
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State | OR
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Zip | 97132-1833
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Country | US
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Telephone | 503-554-0036
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Fax | 503-538-9257
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD19011
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License Number State | OR
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