Provider Demographics
NPI:1992398382
Name:WHITE, ANDREW BOICE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:BOICE
Last Name:WHITE
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 1:34800 BOB WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-5000
Mailing Address - Country:US
Mailing Address - Phone:619-881-9169
Mailing Address - Fax:
Practice Address - Street 1:3D SUPPLY BATTALION, 3D MARINE LOGISTICS GROUP
Practice Address - Street 2:UNIT 38411
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96380-8411
Practice Address - Country:US
Practice Address - Phone:315-637-2528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
VA0101275822208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care Provider