MEDICARE: MR. LOYD G. WHITLEY M.D.

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	207RP1001X	Pulmonary Disease Physician	014335	LA
2	207RP1001X	Pulmonary Disease Physician	F6346	TX

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

General Provider Information

NPI Number	:	1821093360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LOYD G. WHITLEY M.D.

Provider Business Mailing Address
First Line	:	4848 NE STALLINGS DR
Second Line	:	STE 100
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1239
Country	:	US
Telephone Number	:	936-205-5960
Fax Number	:	936-205-5963

Provider Business Practice Location Address
First Line	:	4848 NE STALLINGS DR
Second Line	:	STE 100
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1239
Country	:	US
Telephone Number	:	936-205-5960
Fax Number	:	936-205-5963

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/20/2011

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