Provider Demographics
NPI:1760103162
Name:WHITE, JOSHUA THEODORE (MD, FRSCS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:THEODORE
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD, FRSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BRICKELL BAY DR APT 64N
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3579
Mailing Address - Country:US
Mailing Address - Phone:902-999-5739
Mailing Address - Fax:
Practice Address - Street 1:1150 NW 14TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2137
Practice Address - Country:US
Practice Address - Phone:902-999-5739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME158731208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology