Provider Demographics
NPI:1437602919
Name:THE WHITE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:THE WHITE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-777-2956
Mailing Address - Street 1:2152 E. COOPER AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-5404
Mailing Address - Country:US
Mailing Address - Phone:559-777-2956
Mailing Address - Fax:559-831-3220
Practice Address - Street 1:2152 E COPPER AVE STE 111
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-5404
Practice Address - Country:US
Practice Address - Phone:559-777-2956
Practice Address - Fax:559-831-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1326254624OtherOWNER PAUL WHITE'S NPI