Provider Demographics
NPI:1780684977
Name:WHITE, STANLEY D (PA)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:D
Last Name:WHITE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27535 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4839
Mailing Address - Country:US
Mailing Address - Phone:251-625-0909
Mailing Address - Fax:251-380-7390
Practice Address - Street 1:27535 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4839
Practice Address - Country:US
Practice Address - Phone:251-625-0909
Practice Address - Fax:251-380-7390
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA182363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051503930Medicaid
970022612OtherRAILROAD MEDICARE
AL10297I1545Medicare PIN
AL102I978197Medicare PIN
AL051503930Medicaid