Provider Demographics
NPI:1235377847
Name:EUCLID INTERVENTIONAL PAIN MANAGEMENT, INC
Entity Type:Organization
Organization Name:EUCLID INTERVENTIONAL PAIN MANAGEMENT, INC
Other - Org Name:PETER WHITE, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPANY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-981-6414
Mailing Address - Street 1:350 SOUTH EUCLID AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6665
Mailing Address - Country:US
Mailing Address - Phone:909-981-6414
Mailing Address - Fax:909-981-6415
Practice Address - Street 1:350 SOUTH EUCLID AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6665
Practice Address - Country:US
Practice Address - Phone:909-981-6414
Practice Address - Fax:909-981-6415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50653208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty