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General NPI Number Information
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NPI Number | 1336252477
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Entity Type | Individual
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Provider Name | JOHNNY LEE WHITE JR. MD
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Gender | Male
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 1030 N GRANDVIEW AVE
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City | ODESSA
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State | TX
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Zip | 79761-3149
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Country | US
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Telephone | 877-750-1027
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Fax | 877-750-1079
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Provider Business Mailing Address
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Address Line | 11700 PRESTON RD SUITE 660 PMB-136
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City | DALLAS
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State | TX
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Zip | 75230
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Country | US
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Telephone | 877-750-1027
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Fax | 877-750-1079
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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 | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | G1581
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G1581
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License Number State | TX
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