Healthcare Provider Details

I. General information

NPI: 1417094244
Provider Name (Legal Business Name): ELIZABETH B WHITE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 HIGHLAND PARK PLZ
COVINGTON LA
70433-7130
US

IV. Provider business mailing address

205 HIGHLAND PARK PLZ
COVINGTON LA
70433-7130
US

V. Phone/Fax

Practice location:
  • Phone: 985-871-8681
  • Fax: 985-871-8684
Mailing address:
  • Phone: 985-871-8681
  • Fax: 985-871-8684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number09381R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number09381R
License Number StateLA

VIII. Authorized Official

Name: DR. ELIZABETH B WHITE
Title or Position: OWNER
Credential: MD
Phone: 985-871-8681