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General NPI Number Information
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NPI Number | 1548457559
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Entity Type | Organization
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Legal Business Name | GORDON ELLIS WHITE MD,LLC
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 201 4TH ST MEDICAL PLAZA, STE. 2E
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City | ALEXANDRIA
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State | LA
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Zip | 71301-8421
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Country | US
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Telephone | 318-443-9400
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Fax | 318-442-9406
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Provider Business Mailing Address
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Address Line | 201 4TH ST MEDICAL PLAZA, STE. 2E
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City | ALEXANDRIA
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State | LA
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Zip | 71301-8421
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Country | US
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Telephone | 318-443-9400
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Fax | 318-442-9406
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Authorized Official
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Title or Position | PHYSICAN
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Name | DR. GORDON WHITE
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Credential |
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Telephone | 318-443-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 025398
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License Number State | LA
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