MEDICARE: DR. GORDON AARON 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	207Q00000X	Family Medicine Physician	G6045	TX

General Provider Information

NPI Number	:	1568598084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GORDON AARON WHITNEY MD

Provider Business Mailing Address
First Line	:	7500 W CAMP WISDOM RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75236-5629
Country	:	US
Telephone Number	:	972-708-7408
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 W CAMP WISDOM RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75236-5629
Country	:	US
Telephone Number	:	972-708-7408
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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