Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 5101021044 | MI |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101021044 | MI |
NPI | 1104230523 |
---|---|
Provider Name | Gary Zachary White |
First Address | Battle Creek, MI 49017-3307 |
Second Address | Battle Creek, MI 49017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2014 |
Last Update Date | 25/09/2020 |