Provider Demographics
NPI:1821018318
Name:WHITAKER, KURT T (MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:T
Last Name:WHITAKER
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 1:641 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9192
Mailing Address - Country:US
Mailing Address - Phone:303-929-1910
Mailing Address - Fax:
Practice Address - Street 1:641 CHEYENNE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-9192
Practice Address - Country:US
Practice Address - Phone:303-929-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6176544-1205207PE0004X
CODR.0042353207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services