Provider Demographics
NPI:1588621064
Name:WHITTLE, TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:WHITTLE
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 1:747 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-9342
Mailing Address - Country:US
Mailing Address - Phone:662-494-9466
Mailing Address - Fax:662-494-9900
Practice Address - Street 1:747 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-9342
Practice Address - Country:US
Practice Address - Phone:662-494-9466
Practice Address - Fax:662-494-9900
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11439207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00113076Medicaid
MS160000583Medicare ID - Type Unspecified
MSD00731Medicare UPIN