Individual
PETER R WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 PRO DR, STE D1, CELINA, OH 45822-3307
(419) 394-3387
(419) 586-8509
Mailing address
200 SAINT CLAIR AVE, JTDM FAMILY PRACTICES LLC, SAINT MARYS, OH 45885-2400
(419) 394-3387
(419) 586-8509
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
35-072242
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1942630348
GROUP NPI- GRAND LAKE FAMILY & PEDIATRICS
OH
05
—
2016204
—
OH
01
—
9934723
MEDICARE GROUP PTAN
OH
01
—
H280560
MEDICARE INDIVIDUAL PTAN
OH
Enumeration date
05/30/2006
Last updated
05/01/2014
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