Individual
STEPHANIE M WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1027 BELLEVUE AVE STE 200, SAINT LOUIS, MO 63117-1851
(314) 645-6450
Mailing address
12855 N 40 DR, SUITE 300, SAINT LOUIS, MO 63141-8657
(314) 880-6162
(314) 997-3248
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2007019158
MO
207RC0000X
Cardiovascular Disease Physician
Primary
2013012540
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588863906
—
MO
01
—
2013012540
MISSOURI MEDICAL LICENSE
MO
Enumeration date
07/16/2007
Last updated
11/17/2020
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