Basic Information
| Provider Information | |||||||||
| NPI: | 1164602926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHISENANT | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 FROSTWOOD DR STE 1.100 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770242301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133385519 | ||||||||
| FaxNumber: | 7137043086 | ||||||||
| Practice Location | |||||||||
| Address1: | 6500 38TH AVE N | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337101629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273841414 | ||||||||
| FaxNumber: | 7273458075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2007 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | ME128898 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | 2011015524 | MO | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | N4199 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | MD2022-1392 | NM | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0204X | ME128898 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0202X | FW1856371 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | M9519 | 01 | FL | FL HF MEDICARE | OTHER | 018604800 | 05 | FL | MEDICAID |