Provider Demographics
NPI:1992758270
Name:WHITE, JASON F (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:F
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:53-59 PUBLIC SQUARE
Mailing Address - Street 2:SUITE 301 - WATERTOWN INTERNISTS, PC
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2674
Mailing Address - Country:US
Mailing Address - Phone:315-782-2141
Mailing Address - Fax:315-782-5123
Practice Address - Street 1:53-59 PUBLIC SQUARE SUITE 301
Practice Address - Street 2:WATERTOWN INTERNISTS, PC
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-782-2141
Practice Address - Fax:315-782-5123
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY231919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02571942Medicaid
NY02571942Medicaid