Provider Demographics
NPI:1083703896
Name:WHITE, JONATHAN DOYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DOYLE
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 GREENE 721 RD STE 4
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-8995
Mailing Address - Country:US
Mailing Address - Phone:870-637-0319
Mailing Address - Fax:870-215-0191
Practice Address - Street 1:160 GREENE 721 RD STE 4
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-8995
Practice Address - Country:US
Practice Address - Phone:870-637-0319
Practice Address - Fax:870-215-0191
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR164137001Medicaid
AR5N772Medicare PIN
ARI72359Medicare UPIN
AR1083703896Medicare PIN
AR57297Medicare PIN