Provider Demographics
NPI:1033282512
Name:WHITAKER, JULIAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:M
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4321 BIRCH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1923
Mailing Address - Country:US
Mailing Address - Phone:949-851-1550
Mailing Address - Fax:949-270-0169
Practice Address - Street 1:4321 BIRCH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1923
Practice Address - Country:US
Practice Address - Phone:949-851-1550
Practice Address - Fax:949-270-0169
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2017-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC34663208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35694Medicare UPIN