Provider Demographics
NPI:1639141443
Name:WHITFIELD, JAMES W (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:WHITFIELD
Suffix:
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 1:1801 REDROCK DR
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5655
Mailing Address - Country:US
Mailing Address - Phone:505-863-7993
Mailing Address - Fax:505-863-9406
Practice Address - Street 1:1801 REDROCK DR
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5655
Practice Address - Country:US
Practice Address - Phone:505-863-7993
Practice Address - Fax:505-863-9406
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM89-329207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00181Medicare PIN
D56620Medicare UPIN