MEDICARE: DR. HALL B WHITWORTH MD

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	207RC0000X	Cardiovascular Disease Physician	ME46626	FL

General Provider Information

NPI Number	:	1215921846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HALL B WHITWORTH MD

Provider Business Mailing Address
First Line	:	1745 N MILLS AVENUE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4504
Country	:	US
Telephone Number	:	407-841-7151
Fax Number	:	407-648-2259

Provider Business Practice Location Address
First Line	:	1745 N MILLS AVENUE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4504
Country	:	US
Telephone Number	:	407-841-7151
Fax Number	:	407-648-2259

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	03/05/2010

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