Provider Demographics
NPI:1417094244
Name:ELIZABETH B WHITE MD INC
Entity Type:Organization
Organization Name:ELIZABETH B WHITE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-871-8681
Mailing Address - Street 1:205 HIGHLAND PARK PLZ
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7130
Mailing Address - Country:US
Mailing Address - Phone:985-871-8681
Mailing Address - Fax:985-871-8684
Practice Address - Street 1:205 HIGHLAND PARK PLZ
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7130
Practice Address - Country:US
Practice Address - Phone:985-871-8681
Practice Address - Fax:985-871-8684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09381R207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5R802CT69OtherMEDICARE PTAN
LA5CT69Medicare PIN