Provider Demographics
NPI:1528061587
Name:WHITFILL, CHARLES ROY (M D)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ROY
Last Name:WHITFILL
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3413
Mailing Address - Country:US
Mailing Address - Phone:316-691-4449
Mailing Address - Fax:316-691-4408
Practice Address - Street 1:655 N WOODLAWN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208
Practice Address - Country:US
Practice Address - Phone:316-684-5158
Practice Address - Fax:316-681-1005
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31260207W00000X
KS0431260207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200316860AMedicaid
TX045575001Medicaid
TX87403KOtherBCBSTX
TX045575001Medicaid
KS104683Medicare PIN
KS200316860AMedicaid