Provider Demographics
NPI:1306956156
Name:WHITEHOUSE DO, DENNIS RAY
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:RAY
Last Name:WHITEHOUSE DO
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 1:415 W GUY AVE
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-3200
Mailing Address - Country:US
Mailing Address - Phone:405-238-1170
Mailing Address - Fax:405-238-9342
Practice Address - Street 1:415 W GUY AVE
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-3200
Practice Address - Country:US
Practice Address - Phone:405-238-1170
Practice Address - Fax:405-238-9342
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3608207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100090420BMedicaid
OK$$$$$$$$$MMedicare PIN
G75337Medicare UPIN