Provider Demographics
NPI:1033106042
Name:MASCORRO, WHITNEY VANNOY (MD)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:VANNOY
Last Name:MASCORRO
Suffix:
Gender:F
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:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-1198
Mailing Address - Country:US
Mailing Address - Phone:325-670-4220
Mailing Address - Fax:325-672-8292
Practice Address - Street 1:1924 PINE ST
Practice Address - Street 2:SUITE 401C
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2451
Practice Address - Country:US
Practice Address - Phone:325-670-4080
Practice Address - Fax:325-670-4004
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1910174400000X
TXM1940207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175830201Medicaid
TXI40070Medicare UPIN
TX611956Medicare PIN