Individual
DR. GORDON ELLIS WHITE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1900 E MAIN ST, DANVILLE, IL 61832-5100
(318) 801-4070
(318) 554-4807
Mailing address
1900 E MAIN ST, DANVILLE, IL 61832-5100
(318) 801-4070
(318) 554-4807
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
025398
LA
207Q00000X
Family Medicine Physician
025398
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1423688
—
LA
Enumeration date
10/24/2005
Last updated
06/08/2021
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