Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 0101052682 | VA |
Y | 207Q00000X | Family Doctor | 0101052682 | VA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 0101052682 | VA |
NPI | 1003039892 |
---|---|
Provider Name | Dr. Travis W White |
First Address | Richmond, VA 23226-3540 |
Second Address | Richmond, VA 23226-3540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 23/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1295993376 | (05) | AZ |
1629236716 | (05) | AZ |
1871523191 | (05) | AZ |