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NPI Code Detail

MEDICARE: DR. DAVID ELLIS WHITAKER D.O.

MEDICARE:  DR. DAVID ELLIS WHITAKER  D.O.
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
1207Q00000XFamily Medicine PhysicianOP60061604WA

Other Identifiers

General Provider Information

NPI Number : 1427089663
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID ELLIS WHITAKER D.O.
Provider Business Mailing Address
First Line : PO BOX 3002
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-0302
Country : US
Telephone Number : 360-501-3601
Fax Number : 360-501-3648
Provider Business Practice Location Address
First Line : 1615 DELAWARE ST
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-2367
Country : US
Telephone Number : 360-501-3601
Fax Number : 360-501-3648
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 03/15/2026

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Directions to “ DR. DAVID ELLIS WHITAKER D.O.” Practice Location

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