Provider Demographics
NPI:1194962704
Name:SAMUEL R WHITAKER MD PROF CORP
Entity type:Organization
Organization Name:SAMUEL R WHITAKER MD PROF CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ROBINSON
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-997-3990
Mailing Address - Street 1:2888 LONG BEACH BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1560
Mailing Address - Country:US
Mailing Address - Phone:562-997-3990
Mailing Address - Fax:562-997-4166
Practice Address - Street 1:2888 LONG BEACH BLVD
Practice Address - Street 2:STE 150
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1560
Practice Address - Country:US
Practice Address - Phone:562-997-3990
Practice Address - Fax:562-997-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty