Healthcare Provider Details

I. General information

NPI: 1396765376
Provider Name (Legal Business Name): VERNON WHITE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

589 SOUTH STATE STREET
PROVO UT
84606-5056
US

IV. Provider business mailing address

589 SOUTH STATE STREET
PROVO UT
84606-5056
US

V. Phone/Fax

Practice location:
  • Phone: 801-429-2000
  • Fax: 801-429-2001
Mailing address:
  • Phone: 801-429-2000
  • Fax: 801-429-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number186968-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number1869681205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1869681205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: