Healthcare Provider Details

I. General information

NPI: 1780329920
Provider Name (Legal Business Name): DR. CALEB TANNER WHITE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 SW 40TH ST
MIAMI FL
33175-3530
US

IV. Provider business mailing address

411 E VAUGHN AVE STE 100
RUSTON LA
71270-5975
US

V. Phone/Fax

Practice location:
  • Phone: 305-223-3000
  • Fax:
Mailing address:
  • Phone: 318-254-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2025010924
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: