Provider Demographics
NPI:1124001458
Name:WHITE, WAYNE BARLOW (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:BARLOW
Last Name:WHITE
Suffix:
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 1:1770 W COUNTY ROAD 50 N
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-8443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1473 E STATE ROAD 44 STE 5
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-8292
Practice Address - Country:US
Practice Address - Phone:765-825-0511
Practice Address - Fax:765-827-1247
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100115050Medicaid
IN000000605660OtherANTHEM
IN100115050Medicaid
INM400040763Medicare PIN