Provider Demographics
NPI:1649091661
Name:WHITEROCK, RICHARD ARLAN
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ARLAN
Last Name:WHITEROCK
Suffix:
Gender:M
Credentials:
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 547
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:NV
Mailing Address - Zip Code:89001-0547
Mailing Address - Country:US
Mailing Address - Phone:725-232-0655
Mailing Address - Fax:
Practice Address - Street 1:2111 WINDMILL CIRCLE
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:NV
Practice Address - Zip Code:89001
Practice Address - Country:US
Practice Address - Phone:725-232-0655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist