Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD046736L | PA |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | MD046736L | PA |
NPI | 1225036270 |
---|---|
Provider Name | Dr. Peter F. White |
First Address | Meadville, PA 16335-3057 |
Second Address | Meadville, PA 16335-3057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 08/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012963010001 | (05) | PA |
079117 | MEDICARE PTAN (01) | PA |
F35788 | (02) | PA |