Basic Information
| Provider Information | |||||||||
| NPI: | 1942241963 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 S BURKHARDT RD | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477156006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124730181 | ||||||||
| FaxNumber: | 8124735822 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 S BURKHARDT RD | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477156006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124730181 | ||||||||
| FaxNumber: | 8124735822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 06/07/2012 | ||||||||
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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 | 207L00000X | 26944 | KY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 01030904A | IN | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 01030904A | IN | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 50017752 | 01 | KY | PASSPORT | OTHER | 000000040950 | 01 | IN | BLUE SHIELD | OTHER | 100236760 | 05 | IN | MEDICAID | 000000223701 | 01 | KY | BLUE SHIELD | OTHER | 050003368 | 01 | RAILROAD MEDICARE | OTHER | 64758543 | 05 | KY | MEDICAID |