Provider Demographics
NPI:1780612234
Name:WHITE, GERARD ANTHONY (MED, ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:GERARD
Middle Name:ANTHONY
Last Name:WHITE
Suffix:
Gender:M
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 HERMITAGE DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-2916
Mailing Address - Country:US
Mailing Address - Phone:985-448-2874
Mailing Address - Fax:
Practice Address - Street 1:NICHOLLS STATE UNIVERSITY
Practice Address - Street 2:906 EAST FIRST STREET
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70310-0001
Practice Address - Country:US
Practice Address - Phone:985-493-2612
Practice Address - Fax:985-493-2614
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAJ001082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer