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General NPI Number Information
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NPI Number | 1336146653
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Entity Type | Individual
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Provider Name | BONNIE K WHITE MD
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Gender | Female
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 1100 SAWGRASS VILLAGE DR SUITE 100
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-5048
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Country | US
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Telephone | 904-285-9355
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Fax | 904-285-7442
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Provider Business Mailing Address
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Address Line | 6210 SAINT ANDREWS CT
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-2063
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Country | US
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Telephone | 904-273-8039
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME99063
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35062590
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License Number State | OH
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