Provider Demographics
NPI:1073536322
Name:DAVID, WHITNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:
Last Name:DAVID
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 1:4221 MONTGOMERY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1103
Mailing Address - Country:US
Mailing Address - Phone:505-717-1952
Mailing Address - Fax:505-433-4174
Practice Address - Street 1:1399 WEIMER RD
Practice Address - Street 2:600
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6340
Practice Address - Country:US
Practice Address - Phone:575-751-0334
Practice Address - Fax:575-751-0297
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28204208600000X
NMMD2006-0821208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ522567001Medicaid
NMAA0583OtherMEDICARE
AZ522567001Medicaid