Provider Demographics
NPI:1487694048
Name:WHITLOW, DOUGLAS R (CRNA)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:R
Last Name:WHITLOW
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 SANTA FE ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-1857
Mailing Address - Country:US
Mailing Address - Phone:361-883-6211
Mailing Address - Fax:361-882-4891
Practice Address - Street 1:1102 W 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3503
Practice Address - Country:US
Practice Address - Phone:417-347-1078
Practice Address - Fax:417-347-1079
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN15494367500000X
ARC01211367500000X
MO148194367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4283456OtherBLUE CROSS/ BLUE SHIELD
AR141558701Medicaid
TN4283456OtherBLUE CROSS/ BLUE SHIELD
AR141558701Medicaid