MEDICARE: MR. JOHNNY LEE WHITE JR. 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	208VP0014X	Interventional Pain Medicine Physician	G1581	TX
2	174400000X	Specialist	G1581	TX

General Provider Information

NPI Number	:	1336252477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHNNY LEE WHITE JR. MD

Provider Business Mailing Address
First Line	:	11700 PRESTON RD SUITE 660
Second Line	:	PMB-136
City	:	DALLAS
State	:	TX
Zip	:	75230
Country	:	US
Telephone Number	:	877-750-1027
Fax Number	:	877-750-1079

Provider Business Practice Location Address
First Line	:	1030 N GRANDVIEW AVE
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79761-3149
Country	:	US
Telephone Number	:	877-750-1027
Fax Number	:	877-750-1079

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	01/19/2026

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