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General NPI Number Information
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NPI Number | 1063892529
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Entity Type | Individual
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Provider Name | ANDREW WHITE MD
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Gender | Male
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Dates
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Enumeration Date | 05/31/2015
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Last Update Date | 06/24/2019
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Provider Practice Location Address
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Address Line | 2710 S RIFE MEDICAL LN
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City | ROGERS
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State | AR
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Zip | 72758
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Country | US
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Telephone | 479-338-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 NE BLUFF SPRING AVE
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City | BENTONVILLE
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State | AR
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Zip | 72712-8964
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Country | US
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Telephone | 501-701-8830
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 31420
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | E-11984
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License Number State | AR
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