Individual
MR. RUSSELL WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1950 BLUEWATER BLVD, SUITE 100, NICEVILLE, FL 32578-3887
(850) 897-8081
(850) 897-1520
Mailing address
1950 BLUEWATER BLVD, SUITE 100, NICEVILLE, FL 32578-3887
(850) 897-8081
(850) 897-1520
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
9110128
FL
Other
Enumeration date
02/27/2017
Last updated
02/27/2017
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