Provider Demographics
NPI:1245277011
Name:WHITTINGHAM, ROY (MD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:
Last Name:WHITTINGHAM
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 1:10071 PINES BLVD BLDG B
Mailing Address - Street 2:SUITE A
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024
Mailing Address - Country:US
Mailing Address - Phone:954-589-1611
Mailing Address - Fax:954-589-1946
Practice Address - Street 1:10071 PINES BLVD BLDG B
Practice Address - Street 2:SUITE A
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-963-6500
Practice Address - Fax:954-963-6233
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70512207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256594300Medicaid
FLG88020Medicare UPIN
FL44851XMedicare Oscar/Certification
FL44851XMedicare PIN