Healthcare Provider Details

I. General information

NPI: 1104836436
Provider Name (Legal Business Name): ROBERT KEITH WHITE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 GRAMMONT ST SUITE 410
MONROE LA
71201-7457
US

IV. Provider business mailing address

1608 N 5TH ST
MONROE LA
71201-4732
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-6300
  • Fax: 318-966-6301
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number018539
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: