Provider Demographics
NPI:1053750323
Name:WHITE, STACY ALLAN JR (MD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:ALLAN
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:10140 CENTURION PKWY N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0532
Mailing Address - Country:US
Mailing Address - Phone:904-697-4127
Mailing Address - Fax:904-697-5102
Practice Address - Street 1:807 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8426
Practice Address - Country:US
Practice Address - Phone:904-697-3694
Practice Address - Fax:904-697-3927
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2022-08-03
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Provider Licenses
StateLicense IDTaxonomies
PAMD4657192085P0229X
FLME1442632085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology