Provider Demographics
NPI:1538462262
Name:WHIDDON, JOHN M
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:WHIDDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4029 BRANDON HILL DR
Mailing Address - Street 2:TALLAHASSEE
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2653
Mailing Address - Country:US
Mailing Address - Phone:850-545-1463
Mailing Address - Fax:850-894-1213
Practice Address - Street 1:1906 BUFORD BLVD
Practice Address - Street 2:#2
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4666
Practice Address - Country:US
Practice Address - Phone:850-545-1463
Practice Address - Fax:850-894-1213
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator