Provider Demographics
NPI:1508998790
Name:WHITLOCK, GARY T (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:T
Last Name:WHITLOCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4300 SAPPHIRE CT
Mailing Address - Street 2:STE. 110
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-9019
Mailing Address - Country:US
Mailing Address - Phone:252-830-7561
Mailing Address - Fax:252-413-0932
Practice Address - Street 1:1309 TATUM DR
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4314
Practice Address - Country:US
Practice Address - Phone:252-672-8742
Practice Address - Fax:252-638-3742
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
NC24331207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCXW9329790OtherDEA NUMBER
NCAW329790OtherDEA NUMBER