Provider Demographics
NPI:1225077449
Name:WHITE, JAMES GRADY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GRADY
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1688 W GRANADA BLVD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:386-677-3530
Mailing Address - Fax:386-673-1933
Practice Address - Street 1:1688 W GRANADA BLVD
Practice Address - Street 2:SUITE 2B
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-677-3530
Practice Address - Fax:386-673-1933
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2023-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0011383208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD65418Medicare UPIN