Provider Demographics
NPI:1336308907
Name:WHITE, ROBERT W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:WHITE
Suffix:JR
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 1:3714 N 50TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-2597
Mailing Address - Country:US
Mailing Address - Phone:803-414-5189
Mailing Address - Fax:
Practice Address - Street 1:1520 S 41ST ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-7312
Practice Address - Country:US
Practice Address - Phone:920-320-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-08
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO390732083P0901X
NMMD2008-05542083P0901X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28777841Medicaid
NM51305879Medicaid
NM53938577Medicaid
NM94939063Medicaid
NM01786342Medicaid
NM46650024Medicaid
NM01786342Medicaid
NMNM301538Medicare UPIN
NM53938577Medicaid