Provider Demographics
NPI:1154453132
Name:WHITTEN, RICHARD DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DANIEL
Last Name:WHITTEN
Suffix:
Gender:M
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 1830
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-1830
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:
Practice Address - Street 1:3745 33RD ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-1506
Practice Address - Country:US
Practice Address - Phone:727-525-0006
Practice Address - Fax:727-521-3694
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 97631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00710294OtherRAILROAD MEDICARE PROVIDER NUMBER
FL000190200Medicaid
FLP00710294OtherRAILROAD MEDICARE PROVIDER NUMBER