Healthcare Provider Details

I. General information

NPI: 1831175561
Provider Name (Legal Business Name): JAMES EDWARD WHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 TAMIAMI TRL SUITE B
PORT CHARLOTTE FL
33952-8127
US

IV. Provider business mailing address

3434 HANCOCK BR PKWY
N FT MYERS FL
33903-7094
US

V. Phone/Fax

Practice location:
  • Phone: 855-674-4624
  • Fax: 941-883-8386
Mailing address:
  • Phone: 877-856-3774
  • Fax: 239-599-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME67871
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: