Provider Demographics
NPI:1851314173
Name:WHITE, JAMES ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:225 SMITH AVE N
Mailing Address - Street 2:STE 201
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2533
Mailing Address - Country:US
Mailing Address - Phone:651-241-5305
Mailing Address - Fax:651-241-5140
Practice Address - Street 1:225 SMITH AVE N
Practice Address - Street 2:STE 201
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2533
Practice Address - Country:US
Practice Address - Phone:651-241-5305
Practice Address - Fax:651-241-5140
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN417692084N0400X
WI54612-0202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN47421600Medicaid
05-81571OtherMEDICA
857587OtherAMERICAS PPO
ND10088Medicaid
01020358OtherPREFERRED ONE
MN42B52WHOtherBLUE CROSS BLUE SHIELD
A014OtherTRIWEST
130020429OtherRAILROAD MEDICARE
HP37184OtherHEALTHPARTNERS
130020429OtherRAILROAD MEDICARE
G97935Medicare UPIN