Provider Demographics
NPI:1184914418
Name:WHITWORTH, KEVIN JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOHN
Last Name:WHITWORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4033 TAMPA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3224
Mailing Address - Country:US
Mailing Address - Phone:813-854-2003
Mailing Address - Fax:813-436-5378
Practice Address - Street 1:116 HARBOR VILLAGE LN
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-3402
Practice Address - Country:US
Practice Address - Phone:813-493-1779
Practice Address - Fax:813-641-3821
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2021-06-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME128124208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003147843AMedicaid