Provider Demographics
NPI:1366778136
Name:WHITT, THERESA ANN (MD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:WHITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2501 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-5058
Mailing Address - Country:US
Mailing Address - Phone:325-795-3412
Mailing Address - Fax:325-795-3374
Practice Address - Street 1:2501 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-5058
Practice Address - Country:US
Practice Address - Phone:325-795-3412
Practice Address - Fax:325-795-3374
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ0360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ0360OtherTEXAS MEDICAL LICENSE
TXJ0360OtherTEXAS MEDICAL LICENSE
TXBW3146948OtherDEA