MEDICARE: RACHEL 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	E-4632	AR
2	208000000X	Pediatrics Physician	E-4632	AR

General Provider Information

NPI Number	:	1366481392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL WHITE M.D.

Provider Business Mailing Address
First Line	:	1110 W MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-4304
Country	:	US
Telephone Number	:	501-982-2108
Fax Number	:	501-982-4951

Provider Business Practice Location Address
First Line	:	1110 W MAIN ST
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-4304
Country	:	US
Telephone Number	:	501-982-2108
Fax Number	:	501-982-4951

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	02/24/2012

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