MEDICARE: DR. BLACKMAN LEE WHITE JR. 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	207V00000X	Obstetrics & Gynecology Physician	C-8497	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C8497	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1255331898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLACKMAN LEE WHITE JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 130587
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77219-0587
Country	:	US
Telephone Number	:	713-223-3663
Fax Number	:	713-227-2388

Provider Business Practice Location Address
First Line	:	815 WALKER ST
Second Line	:	SUITE 837
City	:	HOUSTON
State	:	TX
Zip	:	77002-5721
Country	:	US
Telephone Number	:	713-223-3663
Fax Number	:	713-227-2388

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	07/08/2007

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