MEDICARE: DR. BONNIE K WHITE 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	208000000X	Pediatrics Physician	ME99063	FL
2	208000000X	Pediatrics Physician	35062590	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1892968001	OTHER	OH	CIGNA
2	OC07700	OTHER	OH	NATIONWIDE HEALTH PLANS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	341106740029	OTHER	OH	CARESOURCE
5	83307	OTHER	OH	PHCS
6	1006360	OTHER	OH	UNITED HEALTHCARE
7	R62590	OTHER	OH	SUMMA CARE
8	000000127390	OTHER	OH	ANTHEM
9	4211817	OTHER	OH	AETNA
10	53013	OTHER	OH	QUAL CHOICE

General Provider Information

NPI Number	:	1336146653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BONNIE K WHITE MD

Provider Business Mailing Address
First Line	:	6210 SAINT ANDREWS CT
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-2063
Country	:	US
Telephone Number	:	904-273-8039
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 SAWGRASS VILLAGE DR
Second Line	:	SUITE 100
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5048
Country	:	US
Telephone Number	:	904-285-9355
Fax Number	:	904-285-7442

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	04/17/2013

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Directions to “ DR. BONNIE K WHITE MD” Practice Location

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