Provider Demographics
NPI:1093884033
Name:WHITE, ROBERT J (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:WHITE
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:4789 LEAVITT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2136
Mailing Address - Country:US
Mailing Address - Phone:440-246-1200
Mailing Address - Fax:440-246-2275
Practice Address - Street 1:4789 LEAVITT RD
Practice Address - Street 2:SUITE B
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2136
Practice Address - Country:US
Practice Address - Phone:440-246-1200
Practice Address - Fax:440-246-2275
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH36003106213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30005720700OtherBWC
OH480033907OtherRAILROAD MEDICARE
OH21203OtherQUALCHOICE
OH000000230200OtherANTHEM BC/BS
OH7361316OtherAETNA
OH300057207027OtherCARESOURCE
OH2116534Medicaid
OHE03106OtherSUMMA
OH04374OtherKAISER PERM.
OH2116534Medicaid
OH30005720700OtherBWC
OH0870142Medicare PIN