MEDICARE: ALAN L WHITNEY MD

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	MD11291	OR

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
2	97420A005	OTHER	OR	TRICARE
3	C105002	OTHER	OR	PACIFIC SOURCE

General Provider Information

NPI Number	:	1396792784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN L WHITNEY MD

Provider Business Mailing Address
First Line	:	2699 N 17TH ST
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2134
Country	:	US
Telephone Number	:	541-266-3600
Fax Number	:	541-269-0708

Provider Business Practice Location Address
First Line	:	2699 N 17TH ST
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2134
Country	:	US
Telephone Number	:	541-266-3600
Fax Number	:	541-269-0708

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	07/08/2007

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Directions to “ ALAN L WHITNEY MD” Practice Location

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