Healthcare Provider Details

I. General information

NPI: 1912990573
Provider Name (Legal Business Name): STUART W WHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9113 LEESGATE RD
LOUISVILLE KY
40222-5003
US

IV. Provider business mailing address

9800 SHELBYVILLE RD STE 220
LOUISVILLE KY
40223-2992
US

V. Phone/Fax

Practice location:
  • Phone: 502-426-1621
  • Fax: 502-426-7906
Mailing address:
  • Phone: 502-429-8585
  • Fax: 502-429-6157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number32174
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: