Provider Demographics
NPI:1407528433
Name:WHITE, BENJAMIN THOMAS (IDHS, ACLS, PALS)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:THOMAS
Last Name:WHITE
Suffix:
Gender:M
Credentials:IDHS, ACLS, PALS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32508-5116
Mailing Address - Country:US
Mailing Address - Phone:321-704-9871
Mailing Address - Fax:
Practice Address - Street 1:211 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32508-5116
Practice Address - Country:US
Practice Address - Phone:910-367-3328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman