Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 18704 | KY |
N | 208D00000X | General Practice Physician | 18704 | KY |
NPI | 1053507004 |
---|---|
Provider Name | Dr. Steven Devon White |
First Address | New Castle, KY 40050-2568 |
Second Address | New Castle, KY 40050-2568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2007 |
Last Update Date | 12/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64187040 | (05) | KY |