Provider Demographics
NPI:1447710710
Name:WHITAKER, DUSTIN LEE (MD)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:LEE
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 WHITESBURG DR SW STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-4302
Mailing Address - Country:US
Mailing Address - Phone:256-882-3605
Mailing Address - Fax:256-880-1272
Practice Address - Street 1:4704 WHITESBURG DR SW STE 100
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1680
Practice Address - Country:US
Practice Address - Phone:256-882-3605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL47955208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology