Healthcare Provider Details

I. General information

NPI: 1518022953
Provider Name (Legal Business Name): JOHN A WHITE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN A WHITE M.D.

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4551 RANDAG DR
NORTH FORT MYERS FL
33903-4731
US

IV. Provider business mailing address

4551 RANDAG DR
NORTH FORT MYERS FL
33903-4731
US

V. Phone/Fax

Practice location:
  • Phone: 239-458-5452
  • Fax:
Mailing address:
  • Phone: 239-656-6406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME33138
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: