Doctor Name: | MR. LARRY KEITH WHITAKER |
NPI Number: | 1205870649 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.A. |
License Number: | 085002550 |
Business Practice Address: | 801 E Orange St Hoopeston Community Memorial Hospital Dba Charlotte Ann Hoopeston, IL - 609421802 |
Business Phone Number: | 2172835644 |
Business Fax Number: | 2172837432 |
Mailing Address: | 611 W Park St, Bwpc URBANA |
State: | IL |
Postal Code: | 618012500 |
Phone Number: | 2173836792 |
Fax Number: | 2173834752 |
NPI Enumeration Date: | 06/16/2006 |
NPI Last Update Date: | 09/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 085002550 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |