MEDICARE: DR. JOHN MICHAEL WHITE DPM

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	213E00000X	Podiatrist	1221	TX
2	213E00000X	Podiatrist	181	OK
3	213E00000X	Podiatrist	134	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	480027525	OTHER	TX	RAILROAD MEDICARE
7	480015333	OTHER	AR	RAILROAD MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0645790001	OTHER	TX	PALMETTO
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053311142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MICHAEL WHITE DPM

Provider Business Mailing Address
First Line	:	PO BOX 347
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75504-0347
Country	:	US
Telephone Number	:	903-792-2121
Fax Number	:	903-793-6444

Provider Business Practice Location Address
First Line	:	4416 ELIZABETH ST
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-2902
Country	:	US
Telephone Number	:	903-792-2121
Fax Number	:	903-793-6444

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	05/22/2012

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Directions to “ DR. JOHN MICHAEL WHITE DPM” Practice Location

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