Healthcare Provider Details

I. General information

NPI: 1902875057
Provider Name (Legal Business Name): JOHN S WHITE II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 HILLSIDE MANOR CT
SAINT PETERS MO
63376-4144
US

IV. Provider business mailing address

32 HILLSIDE MANOR CT
SAINT PETERS MO
63376-4144
US

V. Phone/Fax

Practice location:
  • Phone: 731-217-8144
  • Fax:
Mailing address:
  • Phone: 731-217-8144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD30788
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: