Provider Demographics
NPI:1750692562
Name:WHITAKER, JAMES AROET (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:AROET
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 N MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-6542
Mailing Address - Country:US
Mailing Address - Phone:208-322-5922
Mailing Address - Fax:208-576-6932
Practice Address - Street 1:1760 N MITCHELL ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-6542
Practice Address - Country:US
Practice Address - Phone:208-322-5922
Practice Address - Fax:208-576-6932
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0794204D00000X, 208100000X
MO2011012585208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1356759781Medicaid
ID1356759781Medicaid