Provider Demographics
NPI:1639121619
Name:WHITTEN, GEORGE B III (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:B
Last Name:WHITTEN
Suffix:III
Gender:M
Credentials:MD
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 36680
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-6680
Mailing Address - Country:US
Mailing Address - Phone:602-234-1803
Mailing Address - Fax:602-234-3748
Practice Address - Street 1:300 W CLARENDON AVE
Practice Address - Street 2:STE 142
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3449
Practice Address - Country:US
Practice Address - Phone:602-234-1803
Practice Address - Fax:602-234-3748
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21218207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ161133Medicaid
A52556Medicare UPIN
AZZMD21218Medicare PIN