Provider Demographics
NPI:1548395890
Name:WHITE, ANTHONY JAMES (RT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JAMES
Last Name:WHITE
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 HIGHWAY 114
Mailing Address - Street 2:
Mailing Address - City:RISON
Mailing Address - State:AR
Mailing Address - Zip Code:71665-7805
Mailing Address - Country:US
Mailing Address - Phone:870-325-7570
Mailing Address - Fax:
Practice Address - Street 1:4250 HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:RISON
Practice Address - State:AR
Practice Address - Zip Code:71665-7805
Practice Address - Country:US
Practice Address - Phone:870-325-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1116040001Medicare NSC