Provider Demographics
NPI:1417932229
Name:WHITE, JUDY LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:LOUISE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:351 SUDDUTH CIR NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5179
Mailing Address - Country:US
Mailing Address - Phone:850-218-3990
Mailing Address - Fax:334-574-0212
Practice Address - Street 1:24245 5TH AVE
Practice Address - Street 2:
Practice Address - City:FLORALA
Practice Address - State:AL
Practice Address - Zip Code:36442-3523
Practice Address - Country:US
Practice Address - Phone:850-218-3990
Practice Address - Fax:334-621-1777
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME535942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049380500Medicaid
FL07511OtherBCBSFL
FL049380500Medicaid
FL07511ZMedicare PIN