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NPI Code Detail

MEDICARE: ROBERT F WHITESIDES JR. MD

MEDICARE: ROBERT F WHITESIDES JR. 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
12085R0202XDiagnostic Radiology Physician7980SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568453322
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT F WHITESIDES JR. MD
Provider Business Mailing Address
First Line : PO BOX 1547
Second Line :
City : SEDALIA
State : MO
Zip : 65302-1547
Country : US
Telephone Number : 660-826-5960
Fax Number : 660-826-4852
Provider Business Practice Location Address
First Line : 2829 E HIGHWAY 76
Second Line :
City : MULLINS
State : SC
Zip : 29574-6035
Country : US
Telephone Number : 843-431-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 10/16/2008

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