Healthcare Provider Details

I. General information

NPI: 1588335822
Provider Name (Legal Business Name): SUSAN E WHITE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 N. KELLY AVENUE SUITE 200
EDMOND OK
73003
US

IV. Provider business mailing address

2820 N. KELLY AVENUE SUITE 200
EDMOND OK
73003
US

V. Phone/Fax

Practice location:
  • Phone: 405-726-8000
  • Fax: 405-726-8101
Mailing address:
  • Phone: 405-726-8000
  • Fax: 405-726-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN E WHITE
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 405-326-8615