Basic Information
| Provider Information | |||||||||
| NPI: | 1003851130 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | EUGENE | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 890 W STETSON AVE STE B | ||||||||
| Address2: | |||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925437311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9515376002 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 890 W STETSON AVE STE B | ||||||||
| Address2: | APEX RADIOLOGY MEDICAL GROUP INC. | ||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925437311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9515376002 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 02/27/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 20A4393 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 020A43934 | 01 | CA | MEDICARE PTAN | OTHER | 020A43935 | 01 | MEDICARE PTAN | OTHER | 020A43936 | 01 | CA | MEDICARE PTAN | OTHER | 00AX43930 | 05 | CA | MEDICAID | 300048952 | 01 | CA | RAILRAOD | OTHER | 300033887 | 01 | CA | RAILROAD | OTHER |