Provider Demographics
NPI:1851556443
Name:SUJI WHITE MD PA
Entity Type:Organization
Organization Name:SUJI WHITE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUJATHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-534-0911
Mailing Address - Street 1:5701 OLD BULLARD RD
Mailing Address - Street 2:PMB 113
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4340
Mailing Address - Country:US
Mailing Address - Phone:903-534-0911
Mailing Address - Fax:903-534-8882
Practice Address - Street 1:455 RICE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3604
Practice Address - Country:US
Practice Address - Phone:903-534-0911
Practice Address - Fax:903-534-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty