Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1974 | CO |
NPI | 1104983857 |
---|---|
Provider Name | Dr. Elvin L White |
First Address | Colorado Springs, CO 80907-6375 |
Second Address | Colorado Springs, CO 80907-6375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 20/02/2008 |