=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225368830
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAUL F WHIPPLE,D.O.,P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2010
-----------------------------------------------------
Last Update Date | 02/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 557 KIRKWOOD RD
-----------------------------------------------------
City | STAR CITY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71667-8843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-628-5391
-----------------------------------------------------
Fax | 870-629-5393
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 557 KIRKWOOD RD
-----------------------------------------------------
City | STAR CITY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71667-8843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-628-5391
-----------------------------------------------------
Fax | 870-629-5393
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. PAUL FREDERICK WHIPPLE
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 870-628-5391
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | R-4516
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------