Provider Demographics
NPI:1922003953
Name:WHITES, BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:WHITES
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 1:1151 N STATE ST
Mailing Address - Street 2:STE 617
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2407
Mailing Address - Country:US
Mailing Address - Phone:601-352-5864
Mailing Address - Fax:601-352-5867
Practice Address - Street 1:1151 N STATE ST
Practice Address - Street 2:STE 617
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2407
Practice Address - Country:US
Practice Address - Phone:601-352-5864
Practice Address - Fax:601-352-5867
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06787207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00014870Medicaid
290004751OtherRAILROAD MEDICARE
MS512 1 290009OtherPTAM
4830011OtherUNITED HEALTHCARE
MS512 1 290009OtherPTAM