Provider Demographics
NPI:1972525723
Name:GONSOULIN, WHITNEY JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:JOSEPH
Last Name:GONSOULIN
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 1:7121 S PADRE ISLAND DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4938
Mailing Address - Country:US
Mailing Address - Phone:361-980-1244
Mailing Address - Fax:361-980-1248
Practice Address - Street 1:7121 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 303
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4938
Practice Address - Country:US
Practice Address - Phone:361-980-1244
Practice Address - Fax:361-980-1248
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4008207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1328871Medicaid
TX173840303OtherMEDICAID GROUP
TX133906108Medicaid
TX133906108Medicaid
LA1328871Medicaid
TX00Z050Medicare PIN