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General NPI Number Information
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NPI Number | 1730529371
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Entity Type | Individual
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Provider Name | JONATHAN ANDREW WHITE P.A.-C
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Gender | Male
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 1015 W WASHBOURNE ST
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City | JAY
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State | OK
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Zip | 74346-4205
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Country | US
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Telephone | 918-253-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 3202 W PITTSBURG ST
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City | BROKEN ARROW
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State | OK
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Zip | 74012-9011
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Country | US
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Telephone | 918-629-2407
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2267
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License Number State | OK
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