Provider Demographics
NPI:1134294382
Name:WHITSITT, FLANAGAN (PA)
Entity Type:Individual
Prefix:MR
First Name:FLANAGAN
Middle Name:
Last Name:WHITSITT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6641 SAN ANGELO AVE
Mailing Address - Street 2:
Mailing Address - City:JOSHUA TREE
Mailing Address - State:CA
Mailing Address - Zip Code:92252-2225
Mailing Address - Country:US
Mailing Address - Phone:760-366-9773
Mailing Address - Fax:951-695-3949
Practice Address - Street 1:6641 SAN ANGELO AVE
Practice Address - Street 2:
Practice Address - City:JOSHUA TREE
Practice Address - State:CA
Practice Address - Zip Code:92252-2225
Practice Address - Country:US
Practice Address - Phone:760-366-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16888174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA16888AOtherMEDICARE PPIN
CAW18949Medicare PIN
CAWPA16888AOtherMEDICARE PPIN