Provider Demographics
NPI:1912140138
Name:WHITE, STANFORD KERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:STANFORD
Middle Name:KERRY
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STANFORD
Other - Middle Name:KERRY
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1717 MAIN ST
Mailing Address - Street 2:SUITE 5200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4612
Mailing Address - Country:US
Mailing Address - Phone:214-712-2430
Mailing Address - Fax:214-712-2444
Practice Address - Street 1:1401 FOUCHER ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3515
Practice Address - Country:US
Practice Address - Phone:504-897-7011
Practice Address - Fax:214-712-2444
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.202910207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program