Provider Demographics
NPI:1902899636
Name:WHITED, EVEREST AUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:EVEREST
Middle Name:AUSTIN
Last Name:WHITED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:103 12TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3960
Mailing Address - Country:US
Mailing Address - Phone:512-251-2357
Mailing Address - Fax:512-990-1570
Practice Address - Street 1:103 12TH ST
Practice Address - Street 2:STE 101
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3960
Practice Address - Country:US
Practice Address - Phone:512-251-2357
Practice Address - Fax:512-990-1570
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2013-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE6685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00116JMedicare ID - Type Unspecified
C23432Medicare UPIN