Provider Demographics
NPI:1972607315
Name:WHITE, ADAM J (PA)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:J
Last Name:WHITE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2817 MCCLELLAND BLVD STE 252
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1647
Mailing Address - Country:US
Mailing Address - Phone:417-206-3103
Mailing Address - Fax:417-206-3102
Practice Address - Street 1:2817 MCCLELLAND BLVD STE 252
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1647
Practice Address - Country:US
Practice Address - Phone:417-206-3103
Practice Address - Fax:417-206-3102
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2009-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2005014703363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ52644Medicare UPIN
MO000095243Medicare PIN