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:
Health care specialties
| Specialty | Code | License # | 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 5 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639169485 | NPPES |
| Louisiana | MEDICAID | 1423688 |
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