Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 13614 | WV |
NPI | 1013925957 |
---|---|
Provider Name | Dr. Joe J White JR. |
First Address | Charleston, WV 25304-1223 |
Second Address | Charleston, WV 25304-1223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 24/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0088033000 | (05) | WV |
A72494 | (02) |