Healthcare Provider Details

I. General information

NPI: 1356278550
Provider Name (Legal Business Name): JAEGAR DEAN WHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E MAIN ST STE A100
PAYSON AZ
85541-4606
US

IV. Provider business mailing address

117 E MAIN ST STE A100
PAYSON AZ
85541-4606
US

V. Phone/Fax

Practice location:
  • Phone: 928-596-4500
  • Fax:
Mailing address:
  • Phone: 928-596-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: