Individual
RANDALL GLEN WHITE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2300 HOSPITAL DR STE 120, BOSSIER CITY, LA 71111
(318) 212-7982
(318) 212-7989
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 212-8951
(318) 212-6752
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
313083
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2417380
—
LA
Enumeration date
04/07/2016
Last updated
06/17/2021
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