Healthcare Provider Details

I. General information

NPI: 1164537502
Provider Name (Legal Business Name): PAUL F WHITE MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41299 TALLGRASS
THE SEA RANCH CA
95497-0016
US

IV. Provider business mailing address

144 ASHBY LN
LOS ALTOS CA
94022-1615
US

V. Phone/Fax

Practice location:
  • Phone: 214-770-3775
  • Fax: 214-770-3775
Mailing address:
  • Phone: 650-559-1754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberJ3263
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: