MEDICARE: DR. JOE J WHITE JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	13614	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013925957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOE J WHITE JR. MD

Provider Business Mailing Address
First Line	:	401 DIVISION ST STE 205
Second Line	:
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25309-1455
Country	:	US
Telephone Number	:	304-342-0821
Fax Number	:	304-345-6679

Provider Business Practice Location Address
First Line	:	401 DIVISION ST STE 205
Second Line	:
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25309-1455
Country	:	US
Telephone Number	:	304-342-0821
Fax Number	:	304-345-6679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	06/29/2023

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