Provider Demographics
NPI:1427088855
Name:WHITE, ROBERT SCOTT (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SCOTT
Last Name:WHITE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 LINDSAY LN STE A
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-4103
Mailing Address - Country:US
Mailing Address - Phone:307-578-1800
Mailing Address - Fax:307-578-1814
Practice Address - Street 1:720 LINDSAY LN STE A
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4103
Practice Address - Country:US
Practice Address - Phone:307-578-1800
Practice Address - Fax:307-578-1814
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-23680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS102662OtherBC/BS
KS102662OtherBC/BS