Provider Demographics
NPI:1124039649
Name:WHITE, BRIAN J (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:WHITE
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Gender:M
Credentials:DO
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Mailing Address - Street 1:1900 23RD ST
Mailing Address - Street 2:STE 1200
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1404
Mailing Address - Country:US
Mailing Address - Phone:330-253-1411
Mailing Address - Fax:330-253-1720
Practice Address - Street 1:6847 N CHESTNUT ST
Practice Address - Street 2:SUITE 325
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3929
Practice Address - Country:US
Practice Address - Phone:330-296-6969
Practice Address - Fax:330-296-7710
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-09-16
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Provider Licenses
StateLicense IDTaxonomies
OH34003638207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0695770Medicaid
OH0695770Medicaid
H018270Medicare PIN