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Russell White, PA

Physician Assistant, Surgical in Niceville, FL. Individual provider (NPI-1).

NPI number1508306473
StatusActive
Last updated in NPPESFeb 27, 2017

Details

NPI
1508306473
Entity type
Individual (NPI-1)
Name
Mr. Russell White
Credential
PA
Sex
Male
Sole proprietor
No
Enumeration date
Feb 27, 2017
Last updated
Feb 27, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363AS0400X Physician Assistant, Surgical9110128FLYes

Practice location

1950 Bluewater Blvd
Suite 100
Niceville, FL 32578-3887

Phone 850-897-8081 · Fax 850-897-1520

Mailing address

1950 Bluewater Blvd
Suite 100
Niceville, FL 32578-3887

Phone 850-897-8081 · Fax 850-897-1520

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