Provider Demographics
NPI:1912123209
Name:WHITE, ELIZABETH F (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:F
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10603 JAY RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-9779
Mailing Address - Country:US
Mailing Address - Phone:208-455-1400
Mailing Address - Fax:208-455-1449
Practice Address - Street 1:600 ROBBINS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4539
Practice Address - Country:US
Practice Address - Phone:208-455-1400
Practice Address - Fax:208-455-1449
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6631207LP2900X, 207LP3000X
IDM6331207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDJ6717OtherBLUE CROSS
ID1130876Medicare ID - Type UnspecifiedMEDICARE
IDF65152Medicare UPIN