Provider Demographics
NPI:1275819385
Name:WHITE, STEVEN CHRISTOPHER (LSA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:CHRISTOPHER
Last Name:WHITE
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:540 MADISON OAK DR
Mailing Address - Street 2:SUITE 610
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3943
Mailing Address - Country:US
Mailing Address - Phone:210-352-5346
Mailing Address - Fax:210-352-5367
Practice Address - Street 1:540 MADISON OAK DR
Practice Address - Street 2:STE 610
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3924
Practice Address - Country:US
Practice Address - Phone:210-352-5346
Practice Address - Fax:210-352-5367
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXSA00515363AS0400X
TX126233363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
126233OtherNBSTSA BOARD CERTIFICATION
TXSA00515OtherLSA LICENSE
TX12678975OtherCAQH
TX8EX202OtherBCBS