Provider Demographics
NPI:1346477452
Name:WHITNEY, IAN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:JAMES
Last Name:WHITNEY
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 1:25723 OLD FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-6605
Mailing Address - Country:US
Mailing Address - Phone:210-450-6810
Mailing Address - Fax:210-450-6023
Practice Address - Street 1:25723 OLD FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78015-6605
Practice Address - Country:US
Practice Address - Phone:210-450-6810
Practice Address - Fax:210-450-6023
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60433488207X00000X
TXP4009207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344521505Medicaid
TX344512501Medicaid
TX344521506OtherCSHCN
WA1346477452Medicaid