MEDICARE: DR. LAWRENCE W WHITLOCK 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	207R00000X	Internal Medicine Physician	8296	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	110218393	OTHER		RAIL RAOD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	93161	OTHER	AR	BCBS AR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4295606	OTHER		AETNA HMO
4	512186	OTHER		VESTICA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	3153163	OTHER	TN	BCBST
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801895206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE W WHITLOCK MD

Provider Business Mailing Address
First Line	:	PO BOX 1000 DEPT 362
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38148-0362
Country	:	US
Telephone Number	:	901-373-9704
Fax Number	:	901-255-5223

Provider Business Practice Location Address
First Line	:	3725 CHAMPION HILLS DR
Second Line	:	SUITE 2000
City	:	MEMPHIS
State	:	TN
Zip	:	38125-2597
Country	:	US
Telephone Number	:	901-367-9001
Fax Number	:	901-565-8787

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	11/30/2011

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