1821016361 NPI number — DR. MOLLY A WHITE MD

Table of content: DR. MOLLY A WHITE MD (NPI 1821016361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821016361 NPI number — DR. MOLLY A WHITE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
MOLLY
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADDISON
Provider Other First Name:
MOLLY
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MOLLY WHITE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821016361
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100371
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32610-0371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-338-2195
Provider Business Mailing Address Fax Number:
352-265-0627

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
922 E CALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STARKE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32091-3616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-368-2300
Provider Business Practice Location Address Fax Number:
904-368-2306
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME87911 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: ME87911 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X , with the licence number: ME87911 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 267327400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010502800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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