Healthcare Provider Details

I. General information

NPI: 1063619229
Provider Name (Legal Business Name): JAMES EDWARD WHITE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S INTERSTATE 35 SUITE 203
GEORGETOWN TX
78628-4126
US

IV. Provider business mailing address

605 WASHINGTON SQUARE DR
LEANDER TX
78641-2268
US

V. Phone/Fax

Practice location:
  • Phone: 512-863-7761
  • Fax:
Mailing address:
  • Phone: 512-423-9885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1174586
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: