Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1221 | TX |
Y | 222Z00000X | Podiatrist | 1221 | TX |
N | 213E00000X | Podiatrist | 134 | AR |
N | 222Z00000X | Podiatrist | 134 | AR |
N | 213E00000X | Podiatrist | 181 | OK |
N | 222Z00000X | Podiatrist | 181 | OK |
NPI | 1053311142 |
---|---|
Provider Name | Dr. John Michael White |
First Address | Texarkana, TX 75504-0347 |
Second Address | Texarkana, TX 75503-2902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 22/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0187395-01 | (05) | TX |
0645790001 | PALMETTO (01) | TX |
100779580A | (05) | OK |
128645717 | (05) | AR |
154960716 | MEDICAID DME (01) | AR |
480015333 | RAILROAD MEDICARE (01) | AR |
480027525 | RAILROAD MEDICARE (01) | TX |
U36082 | (02) |