Provider Demographics
NPI:1528531746
Name:WHITEHOUSE, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WHITEHOUSE
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:PLAZA SALCEDO SUITE 4
Mailing Address - Street 2:CARR 109 KM 2.5
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610
Mailing Address - Country:US
Mailing Address - Phone:787-424-9369
Mailing Address - Fax:787-589-7254
Practice Address - Street 1:PLAZA SALCEDO SUITE 4
Practice Address - Street 2:CARR 109 KM 2.5
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-424-9369
Practice Address - Fax:787-589-7254
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21723502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology