Healthcare Provider Details

I. General information

NPI: 1659325371
Provider Name (Legal Business Name): STEVEN K WHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 21ST AVE N
MYRTLE BEACH SC
29577-7429
US

IV. Provider business mailing address

1275 21ST AVE N
MYRTLE BEACH SC
29577-7429
US

V. Phone/Fax

Practice location:
  • Phone: 843-448-9977
  • Fax: 843-626-7755
Mailing address:
  • Phone: 843-448-9977
  • Fax: 843-626-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number10836
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: