Provider Demographics
NPI:1336233071
Name:WHITAKER, WILLIAM VERNON (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:VERNON
Last Name:WHITAKER
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 1:101 EAGLE RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242
Mailing Address - Country:US
Mailing Address - Phone:205-995-1004
Mailing Address - Fax:205-991-6075
Practice Address - Street 1:101 EAGLE RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242
Practice Address - Country:US
Practice Address - Phone:205-995-1004
Practice Address - Fax:205-991-6075
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8924208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51026585OtherBCBS OF ALABAMA
AL000026585Medicaid
AL000026585Medicaid