Provider Demographics
NPI:1801895206
Name:WHITLOCK, LAWRENCE W (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:W
Last Name:WHITLOCK
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 1000 DEPT 362
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0362
Mailing Address - Country:US
Mailing Address - Phone:901-373-9704
Mailing Address - Fax:901-255-5223
Practice Address - Street 1:3725 CHAMPION HILLS DR
Practice Address - Street 2:SUITE 2000
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2597
Practice Address - Country:US
Practice Address - Phone:901-367-9001
Practice Address - Fax:901-565-8787
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8296207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR93161OtherBCBS AR
TN3159686Medicaid
4295606OtherAETNA HMO
512186OtherVESTICA
MS00122885Medicaid
110218393OtherRAIL RAOD MEDICARE
TN3153163OtherBCBST
TN3151917Medicaid
AR106996001Medicaid
4295606OtherAETNA HMO
TN3151917Medicaid
TN3159686Medicaid
AR106996001Medicaid
TN3151917Medicaid
MS00122885Medicaid