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NPI Code Detail

MEDICARE: WILLIAM WESLEY WHITE JR. D.O.

MEDICARE: WILLIAM WESLEY WHITE JR. D.O.
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
1208100000XPhysical Medicine & Rehabilitation PhysicianDR.0066929CO

General Provider Information

NPI Number : 1508397365
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM WESLEY WHITE JR. D.O.
Provider Business Mailing Address
First Line : 12631 E 17TH AVE # MSF493
Second Line :
City : AURORA
State : CO
Zip : 80045-2527
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11820 DESTINATION DR
Second Line :
City : BROOMFIELD
State : CO
Zip : 80021-2518
Country : US
Telephone Number : 720-848-0000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2017
Last Update Date : 09/23/2021

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