MEDICARE: DAVID JOHN WHITMORE DO

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	02693	KY
2	207Q00000X	Family Medicine Physician	02693	KY
3	207Q00000X	Family Medicine Physician	1674	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	00218366	OTHER	WV	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	930102983	OTHER		RAILROAD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	000000204091	OTHER	KY	BCBS

General Provider Information

NPI Number	:	1275511404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID JOHN WHITMORE DO

Provider Business Mailing Address
First Line	:	PO BOX 1680
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25717-1680
Country	:	US
Telephone Number	:	304-697-1396
Fax Number	:	304-697-2086

Provider Business Practice Location Address
First Line	:	1301 HAL GREER BLVD
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701
Country	:	US
Telephone Number	:	304-525-0572
Fax Number	:

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	11/12/2020

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Directions to “ DAVID JOHN WHITMORE DO” Practice Location

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