Provider Demographics
NPI:1790846590
Name:WHITE, GEORGE STEVEN (MD PA)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:STEVEN
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 KING ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155
Mailing Address - Country:US
Mailing Address - Phone:830-379-9492
Mailing Address - Fax:830-372-2463
Practice Address - Street 1:280 KING ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155
Practice Address - Country:US
Practice Address - Phone:830-379-9492
Practice Address - Fax:830-372-2463
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7961207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089724101Medicaid
FL36Medicare ID - Type Unspecified
TX089724101Medicaid