MEDICARE: RANDAL W 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	207RC0000X	Cardiovascular Disease Physician	F4677	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00898304	OTHER	TX	RAILROAD MEDICARE
3	TXB112502	OTHER	TX	MEDICARE

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
4	8CM527	OTHER		BCBS TX

General Provider Information

NPI Number	:	1851378889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDAL W WHITE MD

Provider Business Mailing Address
First Line	:	4411 MEDICAL DR STE 300
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3824
Country	:	US
Telephone Number	:	210-614-5400
Fax Number	:	210-614-2413

Provider Business Practice Location Address
First Line	:	4411 MEDICAL DR
Second Line	:	STE 300
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3822
Country	:	US
Telephone Number	:	210-614-5400
Fax Number	:	210-614-2413

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	01/18/2022

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Directions to “ RANDAL W WHITE MD” Practice Location

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