Provider Demographics
NPI:1003851130
Name:WHITE, FREDERICK EUGENE (DO)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:EUGENE
Last Name:WHITE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 W STETSON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-7311
Mailing Address - Country:US
Mailing Address - Phone:951-537-6002
Mailing Address - Fax:
Practice Address - Street 1:890 W STETSON AVE STE B
Practice Address - Street 2:APEX RADIOLOGY MEDICAL GROUP INC.
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-7311
Practice Address - Country:US
Practice Address - Phone:951-537-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A43932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A43934OtherMEDICARE PTAN
020A43935OtherMEDICARE PTAN
CA020A43936OtherMEDICARE PTAN
CA00AX43930Medicaid
CA300048952OtherRAILRAOD
CA300033887OtherRAILROAD
020A43935OtherMEDICARE PTAN
CA020A43936Medicare PIN
CA300048952OtherRAILRAOD
CA300033887OtherRAILROAD
CA020A43934OtherMEDICARE PTAN
CA00AX43930Medicaid