White, Gordon Ellis

White, Gordon Ellis is an individual health care provider with primary practice located at 1900 E Main St , Danville IL 61832-5100. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Other Service Providers / Military Health Care Provider. Other Service Providers / Military Health Care Provider is his primary health care specialty. White, Gordon Ellis can be contacted via phone (318) 801-4070.

Contact Information

Primary practice address
1900 E Main St Danville IL 61832-5100
Phone: (318) 801-4070
Fax: (318) 554-4807
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 025398 Louisiana
Other Service Providers / Military Health Care Provider 171000000X 025398 Louisiana

Profile Details

NPI number 1639169485
LBN Legal business name White, Gordon Ellis
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 24th, 2005
Last updated Jun 8th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639169485 NPPES
Louisiana MEDICAID 1423688

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