Provider Demographics
NPI:1386961787
Name:WHATLEY, JOSHUA ALLAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ALLAN
Last Name:WHATLEY
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:P O BOX 123594
Mailing Address - Street 2:DEPT 3594
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-3594
Mailing Address - Country:US
Mailing Address - Phone:337-494-2921
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:4345 NELSON RD STE 102
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4183
Practice Address - Country:US
Practice Address - Phone:337-480-7900
Practice Address - Fax:337-602-6358
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204810207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2107747Medicaid
LAMD.204810OtherSTATE MEDICAL LICENSE