Provider Demographics
NPI:1578683678
Name:WHITE, ROBIN SOUTHWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:SOUTHWARD
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 RENO CORPORATE DR.
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511
Mailing Address - Country:US
Mailing Address - Phone:775-329-5555
Mailing Address - Fax:775-827-4613
Practice Address - Street 1:6880 S MCCARRAN BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6104
Practice Address - Country:US
Practice Address - Phone:775-329-5555
Practice Address - Fax:775-827-4613
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV 4312208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016176Medicaid