MEDICARE: DR. ELIZABETH B WHITE M.D.

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	207R00000X	Internal Medicine Physician	09381R	LA
2	208000000X	Pediatrics Physician	09381R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09381R	OTHER	LA	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1184604399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH B WHITE M.D.

Provider Business Mailing Address
First Line	:	180 GREENBRIAR BLVD
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-7233
Country	:	US
Telephone Number	:	985-809-7171
Fax Number	:	985-809-9470

Provider Business Practice Location Address
First Line	:	180 GREENBRIAR BLVD
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-7233
Country	:	US
Telephone Number	:	985-809-7171
Fax Number	:	985-809-9470

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	09/11/2025

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