Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 025006 | LA |
NPI | 1164435475 |
---|---|
Provider Name | Dr. Stephen Collier White |
First Address | Shreveport, LA 71105 |
Second Address | Shreveport, LA 71105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 11/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1423696 | (05) | LA |
190995401 | (05) | TX |
I35750 | (02) | LA |