Provider Demographics
NPI:1992891279
Name:GUIDRY-WHITE, LEAH E (MD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:E
Last Name:GUIDRY-WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841526
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-0075
Mailing Address - Country:US
Mailing Address - Phone:713-436-0073
Mailing Address - Fax:
Practice Address - Street 1:2734 SUNRISE BLVD
Practice Address - Street 2:SUITE 404
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8514
Practice Address - Country:US
Practice Address - Phone:713-436-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8909207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH39445Medicare UPIN