Provider Demographics
NPI:1881613859
Name:WHITAKER, JOE E (MD)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:E
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 1:4108 HENDERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5750
Mailing Address - Country:US
Mailing Address - Phone:813-289-4321
Mailing Address - Fax:813-287-2949
Practice Address - Street 1:4108 HENDERSON BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5750
Practice Address - Country:US
Practice Address - Phone:813-289-4321
Practice Address - Fax:813-287-2949
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59366207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00004389OtherUNITED
FL062181100Medicaid
FL110178340OtherRAILROAD
FLE83999Medicare UPIN
FL110178340OtherRAILROAD