Provider Demographics
NPI:1831394758
Name:WHITE, RYAN S (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:S
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 GRAYSON TRAIL
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112
Mailing Address - Country:US
Mailing Address - Phone:317-989-7748
Mailing Address - Fax:
Practice Address - Street 1:1300 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173
Practice Address - Country:US
Practice Address - Phone:765-932-4111
Practice Address - Fax:765-932-7433
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11013867A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine