Healthcare Provider Details

I. General information

NPI: 1780684977
Provider Name (Legal Business Name): STANLEY D WHITE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27535 US HIGHWAY 98
DAPHNE AL
36526-4839
US

IV. Provider business mailing address

27535 US HIGHWAY 98
DAPHNE AL
36526-4839
US

V. Phone/Fax

Practice location:
  • Phone: 251-625-0909
  • Fax: 251-380-7390
Mailing address:
  • Phone: 251-625-0909
  • Fax: 251-380-7390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA182
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: