Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | H1331 | TX |
NPI | 1013983121 |
---|---|
Provider Name | Dr. Gordon Leroy White |
First Address | Austin, TX 78731-6400 |
Second Address | Austin, TX 78731-6407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 18/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110304601 | (05) | TX |