Provider Demographics
NPI:1942278817
Name:WHITELEY, HAROLD EDMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:EDMOND
Last Name:WHITELEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:H
Other - Middle Name:EDMOND
Other - Last Name:WHITELEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 24410
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 HILYARD ST
Practice Address - Street 2:SUITE 420
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8122
Practice Address - Country:US
Practice Address - Phone:541-744-0828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD219582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181439Medicaid
C36010Medicare UPIN
ORR104547Medicare PIN
ORRR PTAN 260040706Medicare PIN