Provider Demographics
NPI:1134169816
Name:WHATCOTT, BRETT D (DO)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:D
Last Name:WHATCOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 MARKET TRACE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908
Mailing Address - Country:US
Mailing Address - Phone:479-434-3600
Mailing Address - Fax:479-434-3602
Practice Address - Street 1:2707 MARKET TRCE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-8694
Practice Address - Country:US
Practice Address - Phone:479-434-3600
Practice Address - Fax:833-992-0797
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2230207L00000X, 208VP0014X
OK5515207LP2900X
ARE-2230207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136009003Medicaid
AR5L075Medicare PIN
G20088Medicare UPIN