Healthcare Provider Details

I. General information

NPI: 1104501998
Provider Name (Legal Business Name): ZACHARY THOMAS WHITE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 SCHNUCKS DR
WARRENTON MO
63383-1120
US

IV. Provider business mailing address

668 APPLEWOOD DR
KIRKWOOD MO
63122-2502
US

V. Phone/Fax

Practice location:
  • Phone: 636-462-6106
  • Fax: 636-462-7904
Mailing address:
  • Phone: 314-413-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2026030567
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: