Healthcare Provider Details

I. General information

NPI: 1023066024
Provider Name (Legal Business Name): JUDITH A WHITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E JEFFERSON ST SUITE 205
SEATTLE WA
98122-5698
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-3900
  • Fax: 206-320-3899
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35082313W
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD60575483
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: