Provider Demographics
NPI:1659446102
Name:WHITTEN, JOHN W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:WHITTEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8050 E HIGHWAY 191
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8607
Mailing Address - Country:US
Mailing Address - Phone:432-337-5411
Mailing Address - Fax:432-332-0301
Practice Address - Street 1:8050 E HIGHWAY 191
Practice Address - Street 2:SUITE 200
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8607
Practice Address - Country:US
Practice Address - Phone:432-337-5411
Practice Address - Fax:432-332-0301
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2010-10-05
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Provider Licenses
StateLicense IDTaxonomies
TXE6196207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124550806Medicaid
TXP00024656OtherRAILROAD MEDICARE
TX8H9551OtherBLUE CROSS BLUE SHIELD
TX100268103OtherFIRST CARE NETWORK
TXP00024656OtherRAILROAD MEDICARE
TX8H9551OtherBLUE CROSS BLUE SHIELD