Provider Demographics
NPI:1881615292
Name:MCWHIRT, EDWARD B (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:B
Last Name:MCWHIRT
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:PO BOX 1578
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:KY
Mailing Address - Zip Code:42041-0578
Mailing Address - Country:US
Mailing Address - Phone:270-472-3200
Mailing Address - Fax:270-472-2523
Practice Address - Street 1:1718 PARR AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2071
Practice Address - Country:US
Practice Address - Phone:731-286-4445
Practice Address - Fax:731-286-4452
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY27719208600000X
TN21307208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4047264Medicaid
KY64277197Medicaid
KY64277197Medicaid
KY1560201Medicare ID - Type Unspecified
KYE83783Medicare UPIN
KY0933212Medicare PIN