Individual
JASON W WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10122 E 10TH ST, SUITE 100, INDIANAPOLIS, IN 46229
(317) 355-5717
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01079068A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300017136
—
IN
Enumeration date
05/28/2015
Last updated
06/09/2021
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