Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 55509 | MN |
NPI | 1093001315 |
---|---|
Provider Name | James R White JR. |
First Address | Lafayette, LA 70508-6679 |
Second Address | Lafayette, LA 70508-6679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2011 |
Last Update Date | 11/05/2021 |