Provider Demographics
NPI:1063547503
Name:WHITE, PETER FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:FRANCIS
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1218
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-1218
Mailing Address - Country:US
Mailing Address - Phone:843-379-2939
Mailing Address - Fax:843-379-2949
Practice Address - Street 1:122 RIVERWALK BLVD
Practice Address - Street 2:# A
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8182
Practice Address - Country:US
Practice Address - Phone:843-379-2939
Practice Address - Fax:843-379-2949
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052853207ZD0900X, 207ZP0102X
SC14814207ZD0900X, 207ZP0102X
FL103481207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA052853OtherSTATE MEDICAL LICENSE
SC14814OtherSTATE MEDICAL LICENSE
FLME103481OtherSTATE MEDICAL LICENSE
E28529Medicare UPIN