Provider Demographics
NPI:1508974841
Name:WHITE, JASON F (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:F
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-479-3153
Mailing Address - Fax:812-473-8166
Practice Address - Street 1:6221 PHYSICIANS CT
Practice Address - Street 2:SUITE 1
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4031
Practice Address - Country:US
Practice Address - Phone:812-479-3153
Practice Address - Fax:812-473-8166
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056975A207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20041099OAMedicaid
H06589Medicare UPIN
IN204960BMedicare PIN