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1780631762

NPI Code Detail

MEDICARE: NEWTON KIRKE WHITE MD

MEDICARE: NEWTON KIRKE 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	207L00000X	Anesthesiology Physician	MD00013496	WA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	MD00013496	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780631762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEWTON KIRKE WHITE MD

Provider Business Mailing Address
First Line	:	1221 HIGHLAND AVE
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-2829
Country	:	US
Telephone Number	:	509-758-5511
Fax Number	:	509-758-3566

Provider Business Practice Location Address
First Line	:	1221 HIGHLAND AVE
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-2829
Country	:	US
Telephone Number	:	509-758-5511
Fax Number	:	509-758-4672

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	06/30/2011

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Directions to “ NEWTON KIRKE WHITE MD” Practice Location

Language	Start Address	Practice Location

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