Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 00313 | WV |
N | 2081S0010X | Sports Medicine | 00313 | WV |
N | 213ES0000X | Sports Medicine | 00313 | WV |
N | 213ES0103X | Foot & Ankle Surgery | 00313 | WV |
NPI | 1215923495 |
---|---|
Provider Name | Dr. John Bowman White III |
First Address | Hurricane, WV 25526-9772 |
Second Address | Hurricane, WV 25526-9772 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 17/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0099970000 | (05) | WV |
U60008 | (02) | WV |