Provider Demographics
NPI:1144255258
Name:WHYTE, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:WHYTE
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 1:608 G ST
Mailing Address - Street 2:SUITE 2-B
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2568
Mailing Address - Country:US
Mailing Address - Phone:760-344-3446
Mailing Address - Fax:
Practice Address - Street 1:608 G ST
Practice Address - Street 2:SUITE 2-B
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2568
Practice Address - Country:US
Practice Address - Phone:760-344-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA20787208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A858890Medicaid
CA00A858890Medicaid
CAWA85889BMedicare PIN