Provider Demographics
NPI:1366424186
Name:WHITTON, KEVIN E (DPM)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:E
Last Name:WHITTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SOUTH AVE W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8116
Mailing Address - Country:US
Mailing Address - Phone:706-766-3683
Mailing Address - Fax:
Practice Address - Street 1:110 SOUTH AVE W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8116
Practice Address - Country:US
Practice Address - Phone:706-766-3683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000459213ES0103X
MTMED-POD-LIC-33740213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMED-POD-LIC-33740OtherLICENSE
GA000459OtherSTATE LICENSE NUMBER
MTT97913Medicare UPIN
GA000459OtherSTATE LICENSE NUMBER