Provider Demographics
NPI:1548287089
Name:WHITE, ANDREW J (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:WHITE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:MSC 8515-87-1200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-6124
Mailing Address - Fax:844-616-1418
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED RHEUMATOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6124
Practice Address - Fax:844-616-1418
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-11-15
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Provider Licenses
StateLicense IDTaxonomies
MO106516208000000X, 2080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203970603Medicaid
MO203970603Medicaid
MO370019062Medicare PIN
MO103810152Medicaid
MS6734540Medicaid
TN1516613Medicaid