Healthcare Provider Details

I. General information

NPI: 1780670604
Provider Name (Legal Business Name): AARON E WHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 NORTH ASTER
GREENWOOD AR
72936
US

IV. Provider business mailing address

PO BOX 3528
FORT SMITH AR
72913-3528
US

V. Phone/Fax

Practice location:
  • Phone: 479-996-4111
  • Fax: 479-484-4793
Mailing address:
  • Phone: 479-452-2000
  • Fax: 479-274-2194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE3035
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: