Provider Demographics
NPI:1174839831
Name:G. STEVEN WHITE, M.D.,P.A.
Entity Type:Organization
Organization Name:G. STEVEN WHITE, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAYDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-379-9492
Mailing Address - Street 1:280 S KING ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5835
Mailing Address - Country:US
Mailing Address - Phone:830-379-9492
Mailing Address - Fax:830-372-2463
Practice Address - Street 1:280 S KING ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5835
Practice Address - Country:US
Practice Address - Phone:830-379-9492
Practice Address - Fax:830-372-2463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAF7961261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089724101Medicaid
TXD69256Medicare UPIN