Provider Demographics
NPI:1982861985
Name:WHITT, JEREMY DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DOUGLAS
Last Name:WHITT
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 1:300 S RHODES ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-4215
Mailing Address - Country:US
Mailing Address - Phone:870-735-3664
Mailing Address - Fax:
Practice Address - Street 1:300 S RHODES ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4215
Practice Address - Country:US
Practice Address - Phone:870-735-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6475208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery