Healthcare Provider Details

I. General information

NPI: 1962478461
Provider Name (Legal Business Name): THOMAS EUGENE WHITE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

7875 SKYLINE BLVD
OAKLAND CA
94611-1157
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-2000
  • Fax:
Mailing address:
  • Phone: 510-339-1528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberG-26515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: