Provider Demographics
NPI:1447213848
Name:WHITT, TIMOTHY E (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:WHITT
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:PO BOX 52750
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-2750
Mailing Address - Country:US
Mailing Address - Phone:865-766-8897
Mailing Address - Fax:865-766-8874
Practice Address - Street 1:217 S 3RD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1823
Practice Address - Country:US
Practice Address - Phone:859-239-1220
Practice Address - Fax:859-239-6719
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY364252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000063422OtherBCBS GROUP
KY64059124Medicaid
KY00260005Medicare PIN
KY0687505Medicare PIN
KY0651705Medicare PIN
KY000000063422OtherBCBS GROUP
KY64059124Medicaid
KY0037007Medicare PIN