Provider Demographics
NPI:1376686659
Name:WHITSON, JOSEPH PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PAUL
Last Name:WHITSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1475 MT HOOD AVE
Mailing Address - Street 2:SILVERTON HOSPITAL IMMEDIATE CARE
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071
Mailing Address - Country:US
Mailing Address - Phone:971-983-5360
Mailing Address - Fax:971-983-5370
Practice Address - Street 1:1475 MT HOOD AVE
Practice Address - Street 2:SILVERTON HOSPITAL IMMEDIATE CARE
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071
Practice Address - Country:US
Practice Address - Phone:971-983-5360
Practice Address - Fax:971-983-5370
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO24133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR119207Medicare ID - Type Unspecified
ORG36162Medicare UPIN