MEDICARE: DR. CALVIN WHITE

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	013591	LA

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	:	1699774075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CALVIN WHITE

Provider Business Mailing Address
First Line	:	1699 LAKEVIEW DR
Second Line	:
City	:	OPELOUSAS
State	:	LA
Zip	:	70570-1663
Country	:	US
Telephone Number	:	337-351-9150
Fax Number	:	337-407-8621

Provider Business Practice Location Address
First Line	:	1699 LAKEVIEW DR
Second Line	:
City	:	OPELOUSAS
State	:	LA
Zip	:	70570-1663
Country	:	US
Telephone Number	:	337-351-9150
Fax Number	:	337-407-8621

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	03/24/2021

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Directions to “ DR. CALVIN WHITE ” Practice Location

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