Provider Demographics
NPI:1336404599
Name:WHITE, JOHN RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4400 PALOS VERDES DR E
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6474
Mailing Address - Country:US
Mailing Address - Phone:310-833-3790
Mailing Address - Fax:310-833-3748
Practice Address - Street 1:4400 PALOS VERDES DR E
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-6474
Practice Address - Country:US
Practice Address - Phone:310-833-3790
Practice Address - Fax:310-833-3748
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM6588207U00000X
CACFE23483207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine