Provider Demographics
NPI:1508960733
Name:WHITE, EDWARD ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALAN
Last Name:WHITE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:685 VAIL ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-9510
Mailing Address - Country:US
Mailing Address - Phone:812-386-6650
Mailing Address - Fax:812-386-6698
Practice Address - Street 1:685 VAIL ST
Practice Address - Street 2:DEACONESS CLINIC-PRINCETON
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-9510
Practice Address - Country:US
Practice Address - Phone:812-386-6650
Practice Address - Fax:812-386-6698
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001269A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN257900B1Medicare PIN
INF24526Medicare UPIN