Individual provider · Type 1 NPI

Russell White, PA

Surgical Physician Assistant · Niceville, FL

NPI number 1508306473 Active

Practice location

1950 Bluewater Blvd, Suite 100
Niceville, FL 32578-3887

Fax (850) 897-1520

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400X9110128 (FL)

Surgical Physician Assistant: Definition to come...

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About NPI 1508306473

Russell White, PA's National Provider Identifier is 1508306473, issued on Feb 27, 2017. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Niceville, FL. The record was last updated on Feb 27, 2017.