Individual
ADDISON G WHETSTONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 606-4262
(903) 606-0597
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
R0674
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
374213201
—
TX
05
—
374213202
—
TX
01
—
581281YS6P
MEDICARE
TX
01
—
581281YS6V
MEDICARE
TX
01
—
75-0818167-015
TRICARE
TX
01
—
75-0818167-044
TRICARE
TX
01
—
75-0818167-048
TRICARE
TX
01
—
75-0818167-051
TRICARE
TX
01
—
75-1976930-005
TRICARE
TX
01
—
8GY068
BCBS
TX
01
—
8HE341
BCBS
TX
01
—
P01876971
MEDICARE RAIL ROAD
TX
01
—
P01877171
MEDICARE RAIL ROAD
TX
Enumeration date
04/17/2014
Last updated
07/21/2022
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