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General NPI Number Information
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NPI Number | 1275689051
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Entity Type | Organization
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Legal Business Name | M. GORDON WHITBECK, JR. MD
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 2619 CULVER ROAD ST. 2A
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City | ROCHESTER
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State | NY
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Zip | 14609
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Country | US
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Telephone | 585-342-2410
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Fax | 585-342-9141
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Provider Business Mailing Address
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Address Line | 2619 CULVER ROAD SUITE 2A
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City | ROCHESTER
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State | NY
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Zip | 14609
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Country | US
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Telephone | 585-342-2410
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Fax | 585-342-9141
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JENNIFER J KERN
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Credential |
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Telephone | 585-342-2410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 167261
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License Number State | NY
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