Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 106526 | MO |
N | 207RG0300X | Geriatric Medicine | G46379 | CA |
NPI | 1134417991 |
---|---|
Provider Name | Dr. Richard Barry White |
First Address | Saint Louis, MO 63132-2938 |
Second Address | Saint Louis, MO 63132-2938 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2011 |
Last Update Date | 14/07/2011 |