MEDICARE: DR. BOWEN FAVILLE 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	207Q00000X	Family Medicine Physician	R6A22	MO

General Provider Information

NPI Number	:	1669749222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOWEN FAVILLE WHITE MD

Provider Business Mailing Address
First Line	:	9218 METCALF AVE
Second Line	:	SUITE 402
City	:	OVERLAND PARK
State	:	KS
Zip	:	66212-1476
Country	:	US
Telephone Number	:	816-721-0857
Fax Number	:

Provider Business Practice Location Address
First Line	:	8646 MAIDEN LN
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-3033
Country	:	US
Telephone Number	:	816-721-0857
Fax Number	:

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

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	11/28/2011

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