Provider Demographics
NPI:1770679946
Name:WHITE, JAMES GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GREGORY
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 HILLTOP DR # 1
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0511
Mailing Address - Country:US
Mailing Address - Phone:530-242-1415
Mailing Address - Fax:
Practice Address - Street 1:473 SOUTH ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2105
Practice Address - Country:US
Practice Address - Phone:530-242-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30743208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A307430Medicaid
CAA26213Medicare UPIN
CA00A307430Medicare ID - Type Unspecified