Provider Demographics
NPI:1164435475
Name:WHITE, STEPHEN COLLIER (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:COLLIER
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1455 E BERT KOUNS
Mailing Address - Street 2:HIGHLAND CLINIC, APMC
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105
Mailing Address - Country:US
Mailing Address - Phone:318-798-4484
Mailing Address - Fax:318-798-4412
Practice Address - Street 1:1455 E BERT KOUNS
Practice Address - Street 2:HIGHLAND CLINIC, APMC
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105
Practice Address - Country:US
Practice Address - Phone:318-798-4484
Practice Address - Fax:318-798-4412
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA0250062086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190995401Medicaid
LA1423696Medicaid
TX190995401Medicaid
LAI35750Medicare UPIN
LA4K597Medicare PIN