# WHITE TANK MEDICAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306549837
- **Authorized official:** JUSTIN JAMES WOODSIDE (OWNER)
- **Authorized official phone:** (623) 583-9180

## Contact information

- **Practice address:** 18761 N REEMS RD STE 400, SURPRISE, AZ 85374-8646
- **Practice address phone:** (623) 583-9180
- **Mailing address:** 18761 N REEMS RD STE 400, SURPRISE, AZ 85374-8646

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/23/2023
- **Last updated:** 03/23/2023