Provider Demographics
NPI:1972133403
Name:WHITE, PETER JOHN (LAC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:WHITE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 E LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-1621
Mailing Address - Country:US
Mailing Address - Phone:561-251-2640
Mailing Address - Fax:
Practice Address - Street 1:4047 N 40TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5206
Practice Address - Country:US
Practice Address - Phone:561-251-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist