Healthcare Provider Details

I. General information

NPI: 1164642237
Provider Name (Legal Business Name): AMANDA BONE WHITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA ELIZABETH BONA

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 W 38TH ST SUITE 202
AUSTIN TX
78705-1188
US

IV. Provider business mailing address

1601 RIO GRANDE ST SUITE 340
AUSTIN TX
78701-1137
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-8670
  • Fax:
Mailing address:
  • Phone: 512-324-8960
  • Fax: 512-324-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberM2498
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberM2498
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: