Provider Demographics
NPI:1437155603
Name:WHITE, DEBORAH SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:SUSAN
Last Name:WHITE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:4902 EISENHOWER BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6344
Mailing Address - Country:US
Mailing Address - Phone:813-636-2000
Mailing Address - Fax:813-443-8170
Practice Address - Street 1:12780 RACE TRACK RD
Practice Address - Street 2:STE 300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1395
Practice Address - Country:US
Practice Address - Phone:813-792-9541
Practice Address - Fax:813-443-8170
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2014-10-29
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Provider Licenses
StateLicense IDTaxonomies
FLME80789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259670900Medicaid
FL259670900Medicaid
FL35901ZMedicare PIN