Provider Demographics
NPI:1639373129
Name:CHOUTEAU, WHITNEY LEIGH (DO)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LEIGH
Last Name:CHOUTEAU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 LBJ FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6381
Mailing Address - Country:US
Mailing Address - Phone:972-636-5727
Mailing Address - Fax:972-497-2898
Practice Address - Street 1:6750 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 255
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2875
Practice Address - Country:US
Practice Address - Phone:972-823-3240
Practice Address - Fax:972-823-3241
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5102208VP0014X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2206641 03Medicaid
TXP01083223OtherMEDICARE RAILROAD
TX220664102Medicaid
TX220664101Medicaid
TX220664101Medicaid
TX220664102Medicaid