Provider Demographics
NPI:1184604399
Name:WHITE, ELIZABETH B (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:B
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:180 GREENBRIAR BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7233
Mailing Address - Country:US
Mailing Address - Phone:985-809-7171
Mailing Address - Fax:985-809-9470
Practice Address - Street 1:180 GREENBRIAR BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7233
Practice Address - Country:US
Practice Address - Phone:985-809-7171
Practice Address - Fax:985-809-9470
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09381R207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA09381ROtherSTATE LICENSE NUMBER
LAF61650Medicare UPIN