Provider Demographics
NPI:1841389210
Name:WHITE, A. CLINTON JR (MD)
Entity Type:Individual
Prefix:
First Name:A.
Middle Name:CLINTON
Last Name:WHITE
Suffix:JR
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 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0435
Mailing Address - Country:US
Mailing Address - Phone:409-747-0234
Mailing Address - Fax:409-772-6527
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0435
Practice Address - Country:US
Practice Address - Phone:409-747-0234
Practice Address - Fax:409-772-6527
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7252207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760010407OtherEIN
TXP00439312Medicare PIN
TX00R518Medicare PIN
TX8J9723Medicare PIN
F13182Medicare UPIN
TXCG0510Medicare PIN