Provider Demographics
NPI:1629065891
Name:WHITWORTH, JAMES B (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:WHITWORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59103-0219
Mailing Address - Country:US
Mailing Address - Phone:406-252-5658
Mailing Address - Fax:406-238-3617
Practice Address - Street 1:1245 N 29TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0122
Practice Address - Country:US
Practice Address - Phone:406-252-5658
Practice Address - Fax:406-238-3617
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT69102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0216104Medicaid
260031742OtherRAILROAD MEDICARE
MT14021OtherBLUE CROSS BLUE SHIELD
MT000080470OtherMEDICARE PTAN
MT000080470OtherMEDICARE PTAN