Healthcare Provider Details

I. General information

NPI: 1245221563
Provider Name (Legal Business Name): JEFFREY JASON WHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 MIDLAND RD
SOUTHERN PINES NC
28387-2927
US

IV. Provider business mailing address

2170 MIDLAND RD
SOUTHERN PINES NC
28387-2927
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-2100
  • Fax: 910-295-3625
Mailing address:
  • Phone: 910-295-2100
  • Fax: 910-295-3625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number200201639
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number200201639
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: