Provider Demographics
NPI:1699707638
Name:WHITWORTH, JOHN R (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:WHITWORTH
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 1:2670 UNION AVENUE EXT
Mailing Address - Street 2:SUITE 1220
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4426
Mailing Address - Country:US
Mailing Address - Phone:901-458-9785
Mailing Address - Fax:901-458-8192
Practice Address - Street 1:806 ESTATE PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-0600
Practice Address - Country:US
Practice Address - Phone:901-681-4017
Practice Address - Fax:901-681-4013
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN341432080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR98990OtherBLUE CROSS
MS02724221Medicaid
TN4128673OtherBLUE CROSS
TN3387689Medicaid
TNH41886OtherHEALTHSOURCE
TN19169Medicaid
TN4128673Medicaid
TN185482Medicaid
TN3387689Medicaid
H41886Medicare UPIN