Provider Demographics
NPI:1659589737
Name:WHITEAR, AMBER DAWN (MD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:WHITEAR
Suffix:
Gender:F
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 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:801-475-3100
Mailing Address - Fax:801-475-3101
Practice Address - Street 1:5495 S 500 E
Practice Address - Street 2:STE 310
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6923
Practice Address - Country:US
Practice Address - Phone:801-475-3100
Practice Address - Fax:801-475-3101
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6348809-1205207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1659589737Medicaid
UTU000093475Medicare PIN