Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 1869681205 | UT |
N | 207VX0000X | Obstetrician | 1869681205 | UT |
NPI | 1396765376 |
---|---|
Provider Name | Vernon White |
First Address | Provo, UT 84606-5056 |
Second Address | Provo, UT 84606-5056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 01/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0100201 | UNITED HEALTHCARE (01) | UT |
107005500101 | SELECT HEALTH (01) | UT |
10983 | MEDICAID LICENSE # (01) | UT |
2741 | DMBA (01) | UT |
29088 | CHIP MEDICAID/PEHP (01) | UT |
29088 | PEHP (01) | UT |
4256745 | AETNA (01) | UT |
870515716 | BEECH STREET CORP (01) | UT |
870515716 | GEHA (01) | UT |
870515716004 | (05) | UT |
870515716018 | (05) | UT |
870515716WH1 | EMIA (01) | UT |
F26172 | (02) | UT |
QM0000023756 | ALTIUS (01) | UT |