Healthcare Provider Details

I. General information

NPI: 1730165465
Provider Name (Legal Business Name): RICHARD ERIC WHITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 HEALTHCARE DR
ROCK HILL SC
29732-3858
US

IV. Provider business mailing address

1563 HEALTHCARE DR
ROCK HILL SC
29732-3858
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-6030
  • Fax: 803-329-6035
Mailing address:
  • Phone: 803-329-6030
  • Fax: 803-329-6035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number23867
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: