Provider Demographics
NPI:1063410769
Name:WILHITE, TRIA (MD)
Entity type:Individual
Prefix:
First Name:TRIA
Middle Name:
Last Name:WILHITE
Suffix:
Gender:F
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:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-0511
Mailing Address - Country:US
Mailing Address - Phone:573-406-1301
Mailing Address - Fax:573-406-0511
Practice Address - Street 1:98 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401
Practice Address - Country:US
Practice Address - Phone:573-406-1301
Practice Address - Fax:573-406-0511
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105237207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO259741OtherHEALTHLINK
MO207766544Medicaid
MO102580COtherBLUE CROSS/BLUE SHIELD
MO259741OtherHEALTHLINK
F90840Medicare UPIN
MO207766544Medicaid