Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 23345 | SC |
N | 207Q00000X | Family Doctor | ME108837 | FL |
NPI | 1003815358 |
---|---|
Provider Name | Mr. Michael J White |
First Address | Newberry, SC 29108-3958 |
Second Address | Newberry, SC 29108-9522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 13/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003523200 | (05) | FL |
FD856Z | (02) | FL |
H58521 | (02) | SC |
T74354 | (05) | SC |