Provider Demographics
NPI:1982798591
Name:WHITE, SEAN B (MD)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:B
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:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655
Mailing Address - Country:US
Mailing Address - Phone:319-768-1000
Mailing Address - Fax:319-768-3460
Practice Address - Street 1:1221 S GEAR AVE
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655
Practice Address - Country:US
Practice Address - Phone:319-768-1000
Practice Address - Fax:319-768-3460
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013133207L00000X
IA38055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1982798591Medicaid
IAP00688757OtherRAILROAD MEDICARE
IAI4373017Medicare PIN
IAP00688757OtherRAILROAD MEDICARE
IA1982798591Medicaid