Provider Demographics
NPI:1013915511
Name:WHYTE, MARTHA M (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:M
Last Name:WHYTE
Suffix:
Gender:F
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:PO BOX 54995
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154-4995
Mailing Address - Country:US
Mailing Address - Phone:318-227-4658
Mailing Address - Fax:318-424-6606
Practice Address - Street 1:1 SAINT MARY PL
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4343
Practice Address - Country:US
Practice Address - Phone:318-227-4658
Practice Address - Fax:318-424-6606
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA22398208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics