Provider Demographics
NPI:1821016361
Name:WHITE, MOLLY A (MD)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:NICOLE
Other - Last Name:ADDISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOLLY WHITE
Mailing Address - Street 1:PO BOX 100371
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0371
Mailing Address - Country:US
Mailing Address - Phone:352-338-2195
Mailing Address - Fax:352-265-0627
Practice Address - Street 1:922 E CALL ST
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-3616
Practice Address - Country:US
Practice Address - Phone:904-368-2300
Practice Address - Fax:904-368-2306
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87911207Q00000X, 207P00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267327400Medicaid
FL79267Medicare ID - Type Unspecified
H89991Medicare UPIN
FL79267AMedicare ID - Type Unspecified