Healthcare Provider Details

I. General information

NPI: 1871575365
Provider Name (Legal Business Name): JOHN PHILIP WHITE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 MCINTYRE DR SUITE 350
BLOOMINGTON IN
47403-4221
US

IV. Provider business mailing address

PO BOX 1329
BLOOMINGTON IN
47402-1329
US

V. Phone/Fax

Practice location:
  • Phone: 812-332-2226
  • Fax: 812-339-2934
Mailing address:
  • Phone: 812-353-2154
  • Fax: 812-353-5859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01019116A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: