MEDICARE: DR. JOHN D. WHITE MD

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	207T00000X	Neurological Surgery Physician	MD07095	OR

General Provider Information

NPI Number	:	1760718456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN D. WHITE MD

Provider Business Mailing Address
First Line	:	3582 EL DORADO LOOP S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-9723
Country	:	US
Telephone Number	:	503-378-0265
Fax Number	:

Provider Business Practice Location Address
First Line	:	3582 EL DORADO LOOP S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-9723
Country	:	US
Telephone Number	:	503-378-0265
Fax Number	:

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

Provider Enumeration Date	:	10/30/2009
Last Update Date	:	10/30/2009

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