Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | C4866 | AR |
NPI | 1003870098 |
---|---|
Provider Name | Faber A White |
First Address | Charlotte, NC 28265-0978 |
Second Address | Little Rock, AR 72211-4335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D05001 | (02) | AR |