Organization
GORDON ELLIS WHITE MD,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GORDON WHITE (PHYSICAN)
(318) 443-9400
Entity
Organization
Contact information
Practice address
201 4TH ST, MEDICAL PLAZA, STE. 2E, ALEXANDRIA, LA 71301-8421
(318) 443-9400
(318) 442-9406
Mailing address
201 4TH ST, MEDICAL PLAZA, STE. 2E, ALEXANDRIA, LA 71301-8421
(318) 443-9400
(318) 442-9406
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
025398
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1423688
—
LA
Enumeration date
10/03/2007
Last updated
10/26/2007
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