Provider Demographics
NPI:1790713451
Name:WHITLOCK, JOHN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEE
Last Name:WHITLOCK
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 1:136 FURMAN RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5038
Mailing Address - Country:US
Mailing Address - Phone:828-262-0060
Mailing Address - Fax:828-262-0062
Practice Address - Street 1:136 FURMAN RD
Practice Address - Street 2:SUITE 7
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5038
Practice Address - Country:US
Practice Address - Phone:828-262-0060
Practice Address - Fax:828-262-0062
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28595207RG0300X
TNMD0000009984207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN46417OtherBCBS TN
TN4176479Medicaid
NC8987232Medicaid
NC87232OtherBCBS NC
TN3717918Medicare ID - Type Unspecified
NC211509Medicare ID - Type Unspecified
TN4176479Medicaid