Provider Demographics
NPI:1497796585
Name:WHITEHEAD, BRUCE E (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:E
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12201 MERIT DR STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-3139
Mailing Address - Country:US
Mailing Address - Phone:214-294-8989
Mailing Address - Fax:214-294-8977
Practice Address - Street 1:12201 MERIT DR STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-3139
Practice Address - Country:US
Practice Address - Phone:214-294-8989
Practice Address - Fax:214-294-8977
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89Y375Medicare ID - Type Unspecified
TXF71873Medicare UPIN