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General NPI Number Information
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NPI Number | 1609870682
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Entity Type | Individual
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Provider Name | BRENT J WHITLEY MD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 04/07/2021
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Provider Practice Location Address
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Address Line | 5757 N DIXIE HWY
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City | OAKLAND PARK
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State | FL
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Zip | 33334-4135
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Country | US
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Telephone | 954-776-6000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 551014
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City | TAMPA
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State | FL
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Zip | 33655-1014
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Country | US
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Telephone | 800-476-8646
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Fax | 919-382-3210
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME67493
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License Number State | FL
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