Provider Demographics
NPI:1386722395
Name:WHITMAN, WALTER H (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:H
Last Name:WHITMAN
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 1:1430 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4375
Mailing Address - Country:US
Mailing Address - Phone:503-362-9033
Mailing Address - Fax:503-362-9074
Practice Address - Street 1:1430 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4375
Practice Address - Country:US
Practice Address - Phone:503-362-9033
Practice Address - Fax:503-362-9074
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11337MD174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR00561-1Medicaid
OR11337 MDOtherSTATE LICENSE
OR11337 MDOtherSTATE LICENSE