Provider Demographics
NPI:1407940414
Name:WHITTED, RAYMOND WAYNE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:WAYNE
Last Name:WHITTED
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 NE 50TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3022
Mailing Address - Country:US
Mailing Address - Phone:305-754-2450
Mailing Address - Fax:
Practice Address - Street 1:8740 N KENDALL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2212
Practice Address - Country:US
Practice Address - Phone:305-596-3744
Practice Address - Fax:305-596-3676
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0077737207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300430900Medicaid
FLF32226Medicare UPIN
FL47182Medicare ID - Type Unspecified