Provider Demographics
NPI:1699708289
Name:WHITAKER,WEINTRAUB & GRIZZARD, MD,PA
Entity type:Organization
Organization Name:WHITAKER,WEINTRAUB & GRIZZARD, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-289-4410
Mailing Address - Street 1:4108 HENDERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629
Mailing Address - Country:US
Mailing Address - Phone:813-289-4410
Mailing Address - Fax:813-247-2949
Practice Address - Street 1:4108 HENDERSON BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5750
Practice Address - Country:US
Practice Address - Phone:813-289-4410
Practice Address - Fax:813-247-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCI4733OtherRAILROAD
FL38648OtherBCBS
FLCI4733OtherRAILROAD
FLK0712Medicare ID - Type UnspecifiedMEDICARE