Basic Information
| Provider Information | |||||||||
| NPI: | 1386605335 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | PHILLIP | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21850 | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719031850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702853118 | ||||||||
| FaxNumber: | 8702852759 | ||||||||
| Practice Location | |||||||||
| Address1: | 319 E 13TH ST | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719589541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702853118 | ||||||||
| FaxNumber: | 8702852759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 11/23/2009 | ||||||||
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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 | 207Q00000X | C4867 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 103770001 | 05 | AR | MEDICAID |