Provider Demographics
NPI:1114126679
Name:PACK, WHITNEY W (MD)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:W
Last Name:PACK
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 1:1199 MAIN AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5259
Mailing Address - Country:US
Mailing Address - Phone:970-259-7337
Mailing Address - Fax:970-259-7366
Practice Address - Street 1:1199 MAIN AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5259
Practice Address - Country:US
Practice Address - Phone:970-259-7337
Practice Address - Fax:970-259-7366
Is Sole Proprietor?:No
Enumeration Date:2007-07-15
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X208000000X
CO48986208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics