Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | K8570 | TX |
NPI | 1104854389 |
---|---|
Provider Name | Jeremy C White |
First Address | El Paso, TX 79932-2539 |
Second Address | El Paso, TX 79905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 30/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G91982 | (02) |