Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0011X | Interventional Cardiology | A169147 | CA |
NPI | 1104237007 |
---|---|
Provider Name | Jeremy Shane White |
First Address | San Diego, CA 92127-5705 |
Second Address | Birmingham, AL 35233-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2014 |
Last Update Date | 23/06/2021 |