Provider Demographics
NPI:1497852610
Name:JOHN ANTHONY WHITE,M.D.,P.A.
Entity Type:Organization
Organization Name:JOHN ANTHONY WHITE,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TIPLADY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:386-255-0901
Mailing Address - Street 1:533 N CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2323
Mailing Address - Country:US
Mailing Address - Phone:386-255-0909
Mailing Address - Fax:386-255-4454
Practice Address - Street 1:533 N CLYDE MORRIS BLVD STE A
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2323
Practice Address - Country:US
Practice Address - Phone:386-255-0909
Practice Address - Fax:386-255-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039128207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD65463Medicare UPIN
FL64537Medicare PIN