Healthcare Provider Details

I. General information

NPI: 1316004641
Provider Name (Legal Business Name): CHARLES F WHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4361 RAILROAD AVE
PLEASANTON CA
94566-6611
US

IV. Provider business mailing address

4361 RAILROAD AVE
PLEASANTON CA
94566-6611
US

V. Phone/Fax

Practice location:
  • Phone: 925-462-1755
  • Fax: 925-462-1650
Mailing address:
  • Phone: 925-462-1755
  • Fax: 925-462-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC35987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: