Provider Demographics
NPI:1902822935
Name:WHITE, JANEANA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JANEANA
Middle Name:MARIE
Last Name: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 1:16546 MORGAN RUN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-3962
Mailing Address - Country:US
Mailing Address - Phone:281-704-8696
Mailing Address - Fax:888-807-6593
Practice Address - Street 1:16546 MORGAN RUN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3962
Practice Address - Country:US
Practice Address - Phone:281-704-8696
Practice Address - Fax:888-807-6593
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7702207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1657496Medicaid
TX8B6516Medicare ID - Type Unspecified