Provider Demographics
NPI:1588335822
Name:SUSAN E WHITE MD PLLC
Entity type:Organization
Organization Name:SUSAN E WHITE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-326-8615
Mailing Address - Street 1:2820 N. KELLY AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003
Mailing Address - Country:US
Mailing Address - Phone:405-726-8000
Mailing Address - Fax:405-726-8101
Practice Address - Street 1:2820 N. KELLY AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003
Practice Address - Country:US
Practice Address - Phone:405-726-8000
Practice Address - Fax:405-726-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200473990AMedicaid