Individual
JOHN A. WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6944 E BROADWAY RD, MESA, AZ 85208-1916
(480) 436-5194
Mailing address
4715 N BLACK CANYON HWY APT 1138, PHOENIX, AZ 85015-4072
(225) 955-8457
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R79728
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R79728
TRANSITIONAL TRAINING PERMIT
AZ
Enumeration date
06/29/2022
Last updated
06/29/2022
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