Provider Demographics
NPI:1134417991
Name:WHITE, RICHARD BARRY (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BARRY
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1015 CORPORATE SQUARE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2938
Mailing Address - Country:US
Mailing Address - Phone:314-989-2392
Mailing Address - Fax:314-989-2288
Practice Address - Street 1:1015 CORPORATE SQUARE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-2938
Practice Address - Country:US
Practice Address - Phone:314-989-2392
Practice Address - Fax:314-989-2288
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106526207RG0300X
CAG46379207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine