Provider Demographics
NPI:1053343186
Name:WHITE, JOHN H (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:H
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:417 S KING ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5838
Mailing Address - Country:US
Mailing Address - Phone:830-484-4625
Mailing Address - Fax:830-421-3952
Practice Address - Street 1:411 S KING ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5838
Practice Address - Country:US
Practice Address - Phone:830-484-4625
Practice Address - Fax:830-421-3952
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8571208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1053343186OtherCHAMPUS TRICARE
TX047941202Medicaid
TX047941202Medicaid
TX1053343186OtherCHAMPUS TRICARE
TX5158733OtherUNITED HEALTHCARE
TX8AJ391OtherBLUE CROSS BLUE SHIELD
TX047941202Medicaid