Healthcare Provider Details

I. General information

NPI: 1952627796
Provider Name (Legal Business Name): ALFRED ALFONZO WHITE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26846 RIDGEBROOK DR
WESLEY CHAPEL FL
33544-6780
US

IV. Provider business mailing address

2705 W SAINT ISABEL ST
TAMPA FL
33607-6319
US

V. Phone/Fax

Practice location:
  • Phone: 813-803-7779
  • Fax: 813-877-4578
Mailing address:
  • Phone: 813-879-5795
  • Fax: 813-877-4578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME126880
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME126880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: