Healthcare Provider Details

I. General information

NPI: 1174691034
Provider Name (Legal Business Name): LINDA ANN DOUGHTY WHITE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4511 DOWNMAN RD
NEW ORLEANS LA
70126-3716
US

IV. Provider business mailing address

PO BOX 870458
NEW ORLEANS LA
70187-0458
US

V. Phone/Fax

Practice location:
  • Phone: 504-245-4000
  • Fax: 504-243-1005
Mailing address:
  • Phone: 504-494-6180
  • Fax: 504-243-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number05400R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: