Provider Demographics
NPI:1467482067
Name:WHITAKER, MARY T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:T
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 SHANTARA LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7621
Mailing Address - Country:US
Mailing Address - Phone:972-378-3153
Mailing Address - Fax:972-378-3154
Practice Address - Street 1:3612 SHANTARA LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7621
Practice Address - Country:US
Practice Address - Phone:972-378-3153
Practice Address - Fax:972-378-3154
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0930174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE09470Medicare UPIN