Provider Demographics
NPI:1770683526
Name:WHITE, WILLIAM FENTON (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FENTON
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 1:13 PEMBROKE LN
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-9331
Mailing Address - Country:US
Mailing Address - Phone:949-248-1090
Mailing Address - Fax:
Practice Address - Street 1:32326 COAST HWY
Practice Address - Street 2:SUITE E
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651
Practice Address - Country:US
Practice Address - Phone:949-499-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50759207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0710060Medicare ID - Type UnspecifiedCLIA
CA006507590Medicare ID - Type UnspecifiedPPIN