MEDICARE: CONNIE GAYLE WHITE MD

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	207V00000X	Obstetrics & Gynecology Physician	24085	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000000049755	OTHER	BLUE ACCESS BLUE PREFERRE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0700222	OTHER	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1518968148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE GAYLE WHITE MD

Provider Business Mailing Address
First Line	:	101 MEDICAL HEIGHTS DR
Second Line	:	STE D
City	:	FRANKFORT
State	:	KY
Zip	:	40601-4137
Country	:	US
Telephone Number	:	502-875-2468
Fax Number	:	502-875-2485

Provider Business Practice Location Address
First Line	:	101 MEDICAL HEIGHTS DR
Second Line	:	STE D
City	:	FRANKFORT
State	:	KY
Zip	:	40601-4137
Country	:	US
Telephone Number	:	502-875-2468
Fax Number	:	502-875-2485

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

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	07/08/2007

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