Provider Demographics
NPI:1093723496
Name:WHITE, ROBERT L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1870
Mailing Address - Country:US
Mailing Address - Phone:812-634-5014
Mailing Address - Fax:
Practice Address - Street 1:5550 S EAST ST STE C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1991
Practice Address - Country:US
Practice Address - Phone:317-780-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043583A2084P0800X, 2084P0802X, 2084P0805X
OH35.0907172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200091330Medicaid
000000354072OtherBLUE SHIELD
OH2562089Medicaid
IN906130TMedicare PIN
IN200091330Medicaid
IN231190SSSMedicare PIN
000000354072OtherBLUE SHIELD
OH2562089Medicaid
IN150640TTMedicare PIN