Provider Demographics
NPI:1023168523
Name:WHATMORE, DOUGLAS N (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:N
Last Name:WHATMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3200 CHANNING WAY
Mailing Address - Street 2:STE 205
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7546
Mailing Address - Country:US
Mailing Address - Phone:208-535-4300
Mailing Address - Fax:208-535-4315
Practice Address - Street 1:3200 CHANNING WAY
Practice Address - Street 2:STE 205
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7546
Practice Address - Country:US
Practice Address - Phone:208-535-4300
Practice Address - Fax:208-535-4315
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM6630207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDF93489Medicare UPIN
ID1130896Medicare ID - Type Unspecified