Provider Demographics
NPI:1689687493
Name:WHITMORE, DOUGLAS M (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:M
Last Name:WHITMORE
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 1:1930 NE 47TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7718
Mailing Address - Country:US
Mailing Address - Phone:954-491-8981
Mailing Address - Fax:954-489-0655
Practice Address - Street 1:1930 NE 47TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7718
Practice Address - Country:US
Practice Address - Phone:954-491-8981
Practice Address - Fax:954-489-0655
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064607500Medicaid
FLD63065Medicare UPIN
FL93938Medicare ID - Type Unspecified