Provider Demographics
NPI:1275511404
Name:WHITMORE, DAVID JOHN (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:WHITMORE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717-1680
Mailing Address - Country:US
Mailing Address - Phone:304-697-1396
Mailing Address - Fax:304-697-2086
Practice Address - Street 1:1301 HAL GREER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701
Practice Address - Country:US
Practice Address - Phone:304-525-0572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02693207P00000X, 207Q00000X
WV1674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64025802Medicaid
WV5630298000Medicaid
930102983OtherRAILROAD
WV00218366OtherRR MEDICARE
OH2159006Medicaid
KY000000204091OtherBCBS
WV2021844Medicare PIN
WV2021846Medicare PIN
KY000000204091OtherBCBS
KY64025802Medicaid
930102983Medicare PIN
KY0931008Medicare PIN
930102983OtherRAILROAD
WVH09687Medicare UPIN