Provider Demographics
NPI:1568693919
Name:DR. JOHN K. WHITHAM, PC
Entity Type:Organization
Organization Name:DR. JOHN K. WHITHAM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KENTON
Authorized Official - Last Name:WHITAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-251-8889
Mailing Address - Street 1:2608 W KENOSHA ST
Mailing Address - Street 2:#722
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 W KENOSHA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8917
Practice Address - Country:US
Practice Address - Phone:918-251-8889
Practice Address - Fax:918-258-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3935261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center