Basic Information
| Provider Information | |||||||||
| NPI: | 1063547503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | FRANCIS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1218 | ||||||||
| Address2: | |||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299101218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433792939 | ||||||||
| FaxNumber: | 8433792949 | ||||||||
| Practice Location | |||||||||
| Address1: | 122 RIVERWALK BLVD | ||||||||
| Address2: | # A | ||||||||
| City: | RIDGELAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299368182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433792939 | ||||||||
| FaxNumber: | 8433792949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 10/20/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZD0900X | 052853 | GA | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | 14814 | SC | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | 103481 | FL | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZP0102X | 14814 | SC | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 052853 | GA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 103481 | FL | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 052853 | 01 | GA | STATE MEDICAL LICENSE | OTHER | 14814 | 01 | SC | STATE MEDICAL LICENSE | OTHER | ME103481 | 01 | FL | STATE MEDICAL LICENSE | OTHER |