MEDICARE: DR. DAVEEN WHITTLESEY 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	207V00000X	Obstetrics & Gynecology Physician	D3125	TX

General Provider Information

NPI Number	:	1790829372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVEEN WHITTLESEY M.D.

Provider Business Mailing Address
First Line	:	3784 PALLOS VERDAS DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75229-2740
Country	:	US
Telephone Number	:	214-904-0757
Fax Number	:	972-766-8942

Provider Business Practice Location Address
First Line	:	901 S CENTRAL EXPY
Second Line	:	NORTH BUILDING SECTION C
City	:	RICHARDSON
State	:	TX
Zip	:	75080-7302
Country	:	US
Telephone Number	:	972-766-6195
Fax Number	:	972-766-8942

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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