Provider Demographics
NPI:1568718179
Name:WHITE, BLAINE G (PA-C)
Entity Type:Individual
Prefix:
First Name:BLAINE
Middle Name:G
Last Name:WHITE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:621 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:MT
Mailing Address - Zip Code:59230-2604
Mailing Address - Country:US
Mailing Address - Phone:406-228-3645
Mailing Address - Fax:406-228-3533
Practice Address - Street 1:621 3RD ST S
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-2604
Practice Address - Country:US
Practice Address - Phone:406-228-3645
Practice Address - Fax:406-228-3533
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2020-11-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant