Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | MD.016890 | LA |
Y | 207RI0011X | Interventional Cardiology | MD.016890 | LA |
NPI | 1003913070 |
---|---|
Provider Name | Dr. Jean King White |
First Address | Lake Charles, LA 70601-8991 |
Second Address | Lake Charles, LA 70601-8991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 30/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1377970 | (05) | LA |
B89771 | (02) |