Provider Demographics
NPI:1821080730
Name:WHETSTONE, CHARLES R (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:WHETSTONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1345
Mailing Address - Country:US
Mailing Address - Phone:660-259-2216
Mailing Address - Fax:660-259-3942
Practice Address - Street 1:1026 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1345
Practice Address - Country:US
Practice Address - Phone:660-259-2216
Practice Address - Fax:660-259-3942
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8693207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010568509Medicaid
MO08585145OtherBCBS MO
08585205OtherBCBS MO
MO595956400Medicaid
MO595985805Medicaid
08585235OtherBCBS MO
1612730OtherUHC
MO599225901Medicaid
08585215OtherBCBS MO
MO595956202Medicaid
08585225OtherBCBS MO
MO540568508Medicaid
MO595956103Medicaid
08585245OtherBCBS MO
MO240888040Medicaid
268550Medicare Oscar/Certification
268548Medicare Oscar/Certification
MON774434Medicare ID - Type Unspecified
MO010568509Medicaid
MO595956103Medicaid
MO595956202Medicaid
DA4239Medicare PIN
08585235OtherBCBS MO
C52090Medicare UPIN
268551Medicare Oscar/Certification
P27000002Medicare PIN
MOX494434Medicare PIN