Provider Demographics
NPI:1013007988
Name:WHITAKER, JOHN MCALISTER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MCALISTER
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 612
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-769-5656
Mailing Address - Fax:225-766-6996
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 612
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-769-5656
Practice Address - Fax:225-766-6996
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013632208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121503Medicaid
LA1163881Medicaid
LA1163881Medicaid
MS00121503Medicaid
LAC61339Medicare UPIN