MEDICARE: DR. DEBORAH SUSAN 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	ME80789	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437155603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH SUSAN WHITE M.D.

Provider Business Mailing Address
First Line	:	4902 EISENHOWER BLVD
Second Line	:	SUITE 300
City	:	TAMPA
State	:	FL
Zip	:	33634-6344
Country	:	US
Telephone Number	:	813-636-2000
Fax Number	:	813-443-8170

Provider Business Practice Location Address
First Line	:	12780 RACE TRACK RD
Second Line	:	STE 300
City	:	TAMPA
State	:	FL
Zip	:	33626-1395
Country	:	US
Telephone Number	:	813-792-9541
Fax Number	:	813-443-8170

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	10/29/2014

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