Individual
ELLIOTT KINGMAN WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
540 W SAGAMORE AVE, CLEWISTON, FL 33440-3514
(863) 983-5026
Mailing address
928 SAWGRASS ST, CLEWISTON, FL 33440-0210
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9116146
FL
Other
Enumeration date
06/11/2022
Last updated
11/16/2023
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