MEDICARE: DR. EDWARD ALAN WHITE 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
1	207Q00000X	Family Medicine Physician	02001269A	IN

General Provider Information

NPI Number	:	1508960733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD ALAN WHITE D.O.

Provider Business Mailing Address
First Line	:	685 VAIL ST
Second Line	:
City	:	PRINCETON
State	:	IN
Zip	:	47670-9510
Country	:	US
Telephone Number	:	812-386-6650
Fax Number	:	812-386-6698

Provider Business Practice Location Address
First Line	:	685 VAIL ST
Second Line	:	DEACONESS CLINIC-PRINCETON
City	:	PRINCETON
State	:	IN
Zip	:	47670-9510
Country	:	US
Telephone Number	:	812-386-6650
Fax Number	:	812-386-6698

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

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	12/21/2010

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