Provider Demographics
NPI:1467897389
Name:WHITE, STEVEN A (PA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:A
Last Name:WHITE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:819 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-4105
Mailing Address - Country:US
Mailing Address - Phone:209-836-9700
Mailing Address - Fax:209-836-9761
Practice Address - Street 1:819 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4105
Practice Address - Country:US
Practice Address - Phone:209-836-9700
Practice Address - Fax:209-836-9761
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10321363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical