Provider Demographics
NPI:1750491080
Name:WHITFIELD, STEPHEN BRETT (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BRETT
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 1:215 BROOKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6729
Mailing Address - Country:US
Mailing Address - Phone:304-253-1077
Mailing Address - Fax:304-253-9611
Practice Address - Street 1:215 BROOKSHIRE LN
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6729
Practice Address - Country:US
Practice Address - Phone:304-253-1077
Practice Address - Fax:304-253-9611
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101271336207XX0005X
WV21405207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1811139000Medicaid
WV001712652OtherBCBS
WV4123243Medicare ID - Type Unspecified
WVH85621Medicare UPIN