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General NPI Number Information
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NPI Number | 1023017167
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Entity Type | Individual
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Provider Name | JAY W. WHITE DO
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 05/18/2012
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Provider Practice Location Address
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Address Line | 101 E MINNESOTA ST SUITE 210
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City | RAPID CITY
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State | SD
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Zip | 57701-7756
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Country | US
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Telephone | 605-342-3280
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Fax | 605-721-8458
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Provider Business Mailing Address
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Address Line | 2820 MOUNT RUSHMORE RD
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City | RAPID CITY
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State | SD
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Zip | 57701-5462
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Country | US
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Telephone | 605-342-3280
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Fax | 605-721-8458
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 34007897
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 5101013470
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 7612
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License Number State | SD
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