Healthcare Provider Details

I. General information

NPI: 1407528433
Provider Name (Legal Business Name): BENJAMIN THOMAS WHITE IDHS, ACLS, PALS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SOUTH AVE
PENSACOLA FL
32508-5116
US

IV. Provider business mailing address

211 SOUTH AVE
PENSACOLA FL
32508-5116
US

V. Phone/Fax

Practice location:
  • Phone: 910-367-3328
  • Fax:
Mailing address:
  • Phone: 321-704-9871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: