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NPI Code Detail

MEDICARE: MARK WILLIAM WHITE M.D.

MEDICARE:   MARK WILLIAM 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
1208600000XSurgery PhysicianME75474FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01102622OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1107281OTHERFLFHCP

General Provider Information

NPI Number : 1477559631
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK WILLIAM WHITE M.D.
Provider Business Mailing Address
First Line : 11945 SAN JOSE BLVD
Second Line : STE 300
City : JACKSONVILLE
State : FL
Zip : 32223-1627
Country : US
Telephone Number : 904-396-1725
Fax Number : 904-396-4893
Provider Business Practice Location Address
First Line : 103 MEMORIAL MEDICAL PKWY STE 125
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32117-5672
Country : US
Telephone Number : 386-274-0250
Fax Number : 386-274-0269
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 06/10/2025

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