Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | K5741 | TX |
N | 208600000X | Surgeon | K5741 | TX |
N | 2086S0102X | Surgical Critical Care | K5741 | TX |
Y | 2086S0127X | Trauma Surgeon | K5741 | TX |
NPI | 1023164977 |
---|---|
Provider Name | Dr. Christopher Eric White |
First Address | Live Oak, TX 78233-3260 |
Second Address | Live Oak, TX 78233-3260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 10/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
199093903 | (05) | TX |
813524 | MEDICARE PTAN (01) | TX |