Provider Demographics
NPI:1114959905
Name:WHU, MAYBELLE S (MD)
Entity Type:Individual
Prefix:
First Name:MAYBELLE
Middle Name:S
Last Name:WHU
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 2467
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73648-2467
Mailing Address - Country:US
Mailing Address - Phone:580-303-4664
Mailing Address - Fax:
Practice Address - Street 1:1705 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-4455
Practice Address - Country:US
Practice Address - Phone:580-225-2511
Practice Address - Fax:580-821-5524
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055963L207Q00000X
OK25964207P00000X
TXP1837207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01311906OtherRAILROAD MEDICARE
PA903395OtherHIGHMARK
PA903395OtherHIGHMARK
TXP01311906OtherRAILROAD MEDICARE
TX339623YKN5Medicare PIN