MEDICARE: DR. JERRY CHAD WHITE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2007001654	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336359017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY CHAD WHITE DO

Provider Business Mailing Address
First Line	:	17700 E 39TH ST S
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6725
Country	:	US
Telephone Number	:	816-393-0250
Fax Number	:

Provider Business Practice Location Address
First Line	:	17700 E 39TH ST S
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6725
Country	:	US
Telephone Number	:	816-393-0250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	03/29/2022

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