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NPI Code Detail

MEDICARE: JAY W. WHITE DO

MEDICARE: JAY W. WHITE DO
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
1207YX0905XOtolaryngology/Facial Plastic Surgery Physician34007897OH
2207YX0905XOtolaryngology/Facial Plastic Surgery Physician5101013470MI
3207YX0905XOtolaryngology/Facial Plastic Surgery Physician7612SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023017167
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAY W. WHITE DO
Provider Business Mailing Address
First Line : 2820 MOUNT RUSHMORE RD
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-5462
Country : US
Telephone Number : 605-342-3280
Fax Number : 605-721-8458
Provider Business Practice Location Address
First Line : 101 E MINNESOTA ST
Second Line : SUITE 210
City : RAPID CITY
State : SD
Zip : 57701-7756
Country : US
Telephone Number : 605-342-3280
Fax Number : 605-721-8458
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2005
Last Update Date : 05/18/2012

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Directions to “ JAY W. WHITE DO” Practice Location

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