Provider Demographics
NPI:1669478947
Name:WHITE, ANASTASIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANASTASIA
Middle Name:J
Last Name:WHITE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:339 CONSORT DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4439
Mailing Address - Country:US
Mailing Address - Phone:636-386-9224
Mailing Address - Fax:636-386-7679
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:SJMMC DEPT OF ANES
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:636-386-9224
Practice Address - Fax:636-386-7679
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MO116732207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF85242Medicare UPIN