Provider Demographics
NPI:1477840510
Name:WHITING, JEREMY M (DO)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:M
Last Name:WHITING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2811 WILSHIRE BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4808
Mailing Address - Country:US
Mailing Address - Phone:310-315-5483
Mailing Address - Fax:
Practice Address - Street 1:2811 WILSHIRE BLVD STE 800
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4808
Practice Address - Country:US
Practice Address - Phone:310-315-5483
Practice Address - Fax:310-315-5483
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A17145207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine