Provider Demographics
NPI:1093884033
Name:WHITE, ROBERT J (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:WHITE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1326 LEWIS TURNER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1139
Mailing Address - Country:US
Mailing Address - Phone:850-855-4048
Mailing Address - Fax:850-855-4068
Practice Address - Street 1:1326 LEWIS TURNER BLVD
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1139
Practice Address - Country:US
Practice Address - Phone:850-855-4048
Practice Address - Fax:850-855-4068
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003106213ES0103X
FLPO4267213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30005720700OtherBWC
OH480033907OtherRAILROAD MEDICARE
OH21203OtherQUALCHOICE
OH000000230200OtherANTHEM BC/BS
OH7361316OtherAETNA
OH300057207027OtherCARESOURCE
OH2116534Medicaid
OHE03106OtherSUMMA
OH04374OtherKAISER PERM.
OH2116534Medicaid
OH30005720700OtherBWC
OH0870142Medicare PIN