Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | L4171 | TX |
NPI | 1245263185 |
---|---|
Provider Name | Dr. Anna G White |
First Address | Keller, TX 76248-5483 |
Second Address | Keller, TX 76248-4936 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 02/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H65487 | (02) |