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1255407086

NPI Code Detail

MEDICARE: CLAYTON EARL WHETMORE D.O.

MEDICARE: CLAYTON EARL WHETMORE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	2004030585	MO
2	207Q00000X	Family Medicine Physician	2004030585	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000012067	OTHER	MO	MEDICARE NON-RURAL HEALTH
2	263834	OTHER	MO	MEDICARE RURAL HEALTH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255407086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAYTON EARL WHETMORE D.O.

Provider Business Mailing Address
First Line	:	1205 N MISSOURI ST
Second Line	:
City	:	MACON
State	:	MO
Zip	:	63552-2095
Country	:	US
Telephone Number	:	660-385-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1205 N MISSOURI ST
Second Line	:
City	:	MACON
State	:	MO
Zip	:	63552-2095
Country	:	US
Telephone Number	:	660-385-8700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	01/24/2020

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Directions to “ CLAYTON EARL WHETMORE D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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