Provider Demographics
NPI:1578710281
Name:WHITMAN, ROBERT E (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:WHITMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:390 MAPLE SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052
Mailing Address - Country:US
Mailing Address - Phone:618-498-8310
Mailing Address - Fax:618-498-8439
Practice Address - Street 1:400 MAPLE SUMMIT RD
Practice Address - Street 2:JCH ORTHO CENTER
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052
Practice Address - Country:US
Practice Address - Phone:618-498-8472
Practice Address - Fax:618-498-8461
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK53375OtherMEDICARE PTAN
ID300440OtherBLUE CROSS
IL1134163827OtherGROUP NPI JCH MEDICAL GROUP