Provider Demographics
NPI:1730238783
Name:WHITE, SUZANNE J (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:J
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2644 M ST
Mailing Address - Street 2:STE A
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2826
Mailing Address - Country:US
Mailing Address - Phone:209-827-1440
Mailing Address - Fax:209-827-1571
Practice Address - Street 1:285 MERCEY SPRINGS RD STE D
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3878
Practice Address - Country:US
Practice Address - Phone:209-827-1440
Practice Address - Fax:209-827-1571
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A641920Medicaid
CA00A641920Medicare ID - Type Unspecified
CA00A641920Medicaid