=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356517767
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEREMY BOYD WHITE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2008
-----------------------------------------------------
Last Update Date | 03/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20950 NE 27TH CT STE 302 ARC PLASTIC SURGERY
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-501-2000
-----------------------------------------------------
Fax | 954-603-1151
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20950 NE 27TH CT STE 302 ARC PLASTIC SURGERY
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33180-1232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-501-2000
-----------------------------------------------------
Fax | 954-603-1151
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | 0116019049
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207YX0905X
-----------------------------------------------------
Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
-----------------------------------------------------
License Number | ME107157
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | ME107157
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------