Provider Demographics
NPI:1275537243
Name:WHITE, WILLIAM ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALLEN
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:270-389-0031
Mailing Address - Fax:270-389-3707
Practice Address - Street 1:1700 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437-6242
Practice Address - Country:US
Practice Address - Phone:270-389-0031
Practice Address - Fax:270-389-3707
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25725207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000042177OtherBCBS PIN
KY64257256Medicaid
KY0587001Medicare ID - Type Unspecified
KY00756001Medicare PIN
KYC76510Medicare UPIN