MEDICARE: DR. JOHN S WHITE II 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	MD30788	TN

General Provider Information

NPI Number	:	1902875057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN S WHITE II MD

Provider Business Mailing Address
First Line	:	32 HILLSIDE MANOR CT
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-4144
Country	:	US
Telephone Number	:	731-217-8144
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 HILLSIDE MANOR CT
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-4144
Country	:	US
Telephone Number	:	731-217-8144
Fax Number	:

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	02/17/2026

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