Provider Demographics
NPI:1063619229
Name:WHITE, JAMES EDWARD (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:WHITE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 WASHINGTON SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-2268
Mailing Address - Country:US
Mailing Address - Phone:512-423-9885
Mailing Address - Fax:
Practice Address - Street 1:204 S INTERSTATE 35
Practice Address - Street 2:SUITE 203
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-4126
Practice Address - Country:US
Practice Address - Phone:512-863-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1174586174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist