Provider Demographics
NPI:1215048137
Name:WHITE, JERROLD L (MD)
Entity type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:L
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:621 S ILLINOIS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-494-3041
Mailing Address - Fax:641-494-3059
Practice Address - Street 1:1010 4TH ST SW STE 340
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2856
Practice Address - Country:US
Practice Address - Phone:641-422-7766
Practice Address - Fax:641-422-7788
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA26664207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03151OtherWELLMARK
IA1043091Medicaid
IA1043091Medicaid
IAI1955Medicare ID - Type Unspecified