Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | MD.11109R | LA |
NPI | 1265450308 |
---|---|
Provider Name | Dr. Michael White |
First Address | New Orleans, LA 70121-2429 |
Second Address | Mandeville, LA 70448-3502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1655015 | (05) | LA |
H15555 | (02) |