Provider Demographics
NPI:1316913254
Name:WHITING, JOHN H JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:WHITING
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:444 HOSPITAL WAY
Mailing Address - Street 2:SUITE 701
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2701
Mailing Address - Country:US
Mailing Address - Phone:208-233-7931
Mailing Address - Fax:208-233-0423
Practice Address - Street 1:444 HOSPITAL WAY
Practice Address - Street 2:SUITE 701
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2701
Practice Address - Country:US
Practice Address - Phone:208-233-7931
Practice Address - Fax:208-233-0423
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-86252085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1107122Medicare ID - Type Unspecified
G88302Medicare UPIN