Provider Demographics
NPI:1588676696
Name:WHITE, ALBERT TAYLOR JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:TAYLOR
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:809 UNIVERSITY BLVD E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2029
Mailing Address - Country:US
Mailing Address - Phone:205-633-3541
Mailing Address - Fax:205-633-3544
Practice Address - Street 1:809 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2029
Practice Address - Country:US
Practice Address - Phone:205-633-3541
Practice Address - Fax:205-633-3544
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14985207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529502100Medicaid
AL631138634OtherTRICARE REGION 3/4
AL051028014OtherBLUE CROSS BLUE SHIELD
AL000028014Medicare ID - Type Unspecified
ALE28714Medicare UPIN