Provider Demographics
NPI:1124028931
Name:WHITAKER, JAMES A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 47572
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-7572
Mailing Address - Country:US
Mailing Address - Phone:316-261-3130
Mailing Address - Fax:316-261-3275
Practice Address - Street 1:848 N SAINT FRANCIS ST
Practice Address - Street 2:SUITE 2945
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3800
Practice Address - Country:US
Practice Address - Phone:316-261-3130
Practice Address - Fax:316-261-3275
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-15802207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100080720CMedicaid
KS100080720CMedicaid
KS103213Medicare PIN