Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 14834 | AZ |
N | 207QA0505X | Family Doctor - Adult Medicine | 14834 | AZ |
NPI | 1205067386 |
---|---|
Provider Name | Robert August White |
First Address | Tucson, AZ 85756-8699 |
Second Address | Tucson, AZ 85756-8699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 06/08/2009 |