Healthcare Provider Details

I. General information

NPI: 1407859374
Provider Name (Legal Business Name): STEVEN WILLIAM WHITE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 C. LIVE OAK STREET
BEAUFORT NC
28516-1581
US

IV. Provider business mailing address

125 S LAKESHORE DR
WHISPERING PINES NC
28327-9340
US

V. Phone/Fax

Practice location:
  • Phone: 252-728-5737
  • Fax: 252-728-5739
Mailing address:
  • Phone: 910-235-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number102116
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: