Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 34007897 | OH |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101013470 | MI |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 7612 | SD |
NPI | 1023017167 |
---|---|
Provider Name | Jay W. White |
First Address | Rapid City, SD 57701-5462 |
Second Address | Rapid City, SD 57701-7756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 18/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2338947 | (05) | OH |
6632340 | (05) | SD |
H62669 | (02) | OH |