Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 24530 | AZ |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 25430 | AZ |
NPI | 1740272798 |
---|---|
Provider Name | Dr. Gregory Richard White |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 22/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
388670 | (05) | AZ |
G49292 | (02) | AZ |