Provider Demographics
NPI:1487653267
Name:WHITAKER, STANLEY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:WAYNE
Last Name:WHITAKER
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:PO BOX 2048
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-2048
Mailing Address - Country:US
Mailing Address - Phone:603-447-3313
Mailing Address - Fax:603-447-4310
Practice Address - Street 1:24 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818
Practice Address - Country:US
Practice Address - Phone:603-447-3313
Practice Address - Fax:603-447-4310
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH87882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
200597587OtherTIMBERLINE TAX ID
593763829OtherSOUND MED IMAGING TAX ID