Provider Demographics
NPI:1558360412
Name:WHITTAKER, DAVID STANTON JR (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:STANTON
Last Name:WHITTAKER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:169 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5069
Mailing Address - Country:US
Mailing Address - Phone:828-264-4553
Mailing Address - Fax:828-262-3649
Practice Address - Street 1:169 BIRCH ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5069
Practice Address - Country:US
Practice Address - Phone:828-264-4553
Practice Address - Fax:828-262-3649
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200000665207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126F4Medicaid
NC89126F4Medicaid
H13321Medicare UPIN