MEDICARE: M. GORDON WHITBECK JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	167261	NY
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	167261	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316944622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	M. GORDON WHITBECK JR. M.D.

Provider Business Mailing Address
First Line	:	100 KINGS HWY S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-5504
Country	:	US
Telephone Number	:	585-922-0553
Fax Number	:	585-922-0496

Provider Business Practice Location Address
First Line	:	2619 CULVER RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14609-1738
Country	:	US
Telephone Number	:	585-342-2410
Fax Number	:	585-342-9141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	05/05/2021

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