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General NPI Number Information
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NPI Number | 1437461456
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Entity Type | Individual
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Provider Name | RYAN MICHAEL WHITAKER AU.D
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Gender | Male
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Dates
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Enumeration Date | 07/07/2010
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 1054 EAST RIVERSIDE DR. SUITE 201
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City | ST. GEORGE
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State | UT
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Zip | 84790-4825
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Country | US
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Telephone | 435-688-8991
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Fax | 435-688-2122
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Provider Business Mailing Address
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Address Line | 1054 EAST RIVERSIDE DR SUITE 201
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City | ST. GEORGE
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State | UT
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Zip | 84790-4825
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Country | US
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Telephone | 435-688-8991
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Fax | 435-688-2122
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 7718018-4101
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License Number State |
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 7718018-4101
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License Number State | UT
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