Provider Demographics
NPI:1578530960
Name:WHITEFIELD, BARRETT D (DO)
Entity Type:Individual
Prefix:
First Name:BARRETT
Middle Name:D
Last Name:WHITEFIELD
Suffix:
Gender:M
Credentials:DO
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 14047
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79768-4047
Mailing Address - Country:US
Mailing Address - Phone:432-362-8766
Mailing Address - Fax:432-550-7450
Practice Address - Street 1:6110 EASTRIDGE RD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-5002
Practice Address - Country:US
Practice Address - Phone:432-362-8766
Practice Address - Fax:432-550-7450
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154208602Medicaid
TX610710Medicare PIN
TX154208602Medicaid