Provider Demographics
NPI:1073550323
Name:WITHERRITE, TROY R (MD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:R
Last Name:WITHERRITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 SKYLINE DR
Mailing Address - Street 2:BOX 1519
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672-1519
Mailing Address - Country:US
Mailing Address - Phone:509-493-9533
Mailing Address - Fax:509-493-9538
Practice Address - Street 1:212 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-0212
Practice Address - Country:US
Practice Address - Phone:509-493-2133
Practice Address - Fax:509-493-9538
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33240207Q00000X
WA46597207Q00000X
ORMD27358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8456261Medicaid
WAP00332926OtherPTAN
OR271243Medicaid
WA8860880Medicare ID - Type Unspecified
OR271243Medicaid
WA503836Medicare Oscar/Certification
WA8456261Medicaid