Provider Demographics
NPI:1821093360
Name:WHITLEY, LOYD G (MD)
Entity Type:Individual
Prefix:MR
First Name:LOYD
Middle Name:G
Last Name:WHITLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4848 NE STALLINGS DR
Mailing Address - Street 2:STE 100
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1239
Mailing Address - Country:US
Mailing Address - Phone:936-205-5960
Mailing Address - Fax:936-205-5963
Practice Address - Street 1:4848 NE STALLINGS DR
Practice Address - Street 2:STE 100
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1239
Practice Address - Country:US
Practice Address - Phone:936-205-5960
Practice Address - Fax:936-205-5963
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA014335207RP1001X
TXF6346207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1943410Medicaid
LA1943410Medicaid
TXTXB130183Medicare PIN
LAB61844Medicare UPIN