Provider Demographics
NPI:1023180114
Name:WHITE, ROY MATISON JR (MD)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:MATISON
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2211 E NORTHERN LIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4103
Mailing Address - Country:US
Mailing Address - Phone:907-279-8486
Mailing Address - Fax:907-257-8180
Practice Address - Street 1:2211 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4103
Practice Address - Country:US
Practice Address - Phone:907-279-8486
Practice Address - Fax:907-257-8180
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK1170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1170Medicaid
AKMD1170Medicaid
AK00WCHKZGMedicare UPIN
C96970Medicare UPIN