Doctor Name: | DR. DEREK CASPER WHITAKER |
NPI Number: | 1194791707 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 0101102607 |
Business Practice Address: | 300 W Hospital Rd Fort Gordon Fort Gordon, GA - 309055741 |
Business Phone Number: | 7067876158 |
Business Fax Number: | 7067872130 |
Mailing Address: | 300 W Hospital Rd, Fort Gordon FORT GORDON |
State: | GA |
Postal Code: | 309055741 |
Phone Number: | 7067876158 |
Fax Number: | 7067872130 |
NPI Enumeration Date: | 02/23/2006 |
NPI Last Update Date: | 09/14/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 0101102607 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | VA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |