White, Mattie

White, Mattie is an individual health care provider with primary practice located at 3197 Portis Ave , Saint Louis MO 63116-2023. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. White, Mattie can be contacted via phone (618) 713-3847.

Contact Information

Primary practice address
3197 Portis Ave Saint Louis MO 63116-2023
Phone: (618) 713-3847
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 2008014947 Missouri
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036103546 Illinois

Profile Details

NPI number 1316912892
LBN Legal business name White, Mattie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 20th, 2006
Last updated Oct 17th, 2017 - about 8 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 1316912892 NPPES
Missouri MEDICAID 1316912892
Missouri Other CB3700
Missouri Other 659580
Missouri Other P00189155
Missouri Other K04489
Missouri Other 10007459
Missouri MEDICAID 036103546
Missouri Other 460661

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