White, Randall Glen

White, Randall Glen is an sole proprietor health care provider with primary practice located at 2300 Hospital Dr Ste 120 , Bossier City LA 71111. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. White, Randall Glen can be contacted via phone (318) 212-7982.

Contact Information

Primary practice address
2300 Hospital Dr Ste 120 Bossier City LA 71111
Fax: (318) 212-7989
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 313083 Louisiana

Profile Details

NPI number 1295199016
LBN Legal business name White, Randall Glen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 7th, 2016
Last updated Jun 17th, 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 1295199016 NPPES
Louisiana MEDICAID 2417380

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