Provider Demographics
NPI:1851548010
Name:WHITNEY, DAVID STAFFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STAFFORD
Last Name:WHITNEY
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 1:1045 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-5414
Mailing Address - Country:US
Mailing Address - Phone:360-385-6190
Mailing Address - Fax:
Practice Address - Street 1:1045 QUINCY ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-5414
Practice Address - Country:US
Practice Address - Phone:360-385-6190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00010506207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
601-432692OtherWA STATE UBI
WA44034OtherWA STATE LABOR AND INDUSTRIES
WA1079680Medicaid
WAC96697Medicare UPIN
WA201404Medicare PIN