Healthcare Provider Details

I. General information

NPI: 1063754596
Provider Name (Legal Business Name): RYAN C WHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 GAUSE BLVD
SLIDELL LA
70458-2840
US

IV. Provider business mailing address

736 GAUSE BLVD
SLIDELL LA
70458-2840
US

V. Phone/Fax

Practice location:
  • Phone: 318-709-9616
  • Fax: 910-240-9710
Mailing address:
  • Phone: 985-718-1455
  • Fax: 985-326-7580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.207713
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number207713
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: