Basic Information
| Provider Information | |||||||||
| NPI: | 1952627796 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | ALFRED | ||||||||
| MiddleName: | ALFONZO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2705 W SAINT ISABEL ST | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336076319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138795795 | ||||||||
| FaxNumber: | 8138774578 | ||||||||
| Practice Location | |||||||||
| Address1: | 26846 RIDGEBROOK DR | ||||||||
| Address2: | |||||||||
| City: | WESLEY CHAPEL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335446780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138037779 | ||||||||
| FaxNumber: | 8138774578 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2010 | ||||||||
| LastUpdateDate: | 07/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207WX0107X | ME126880 | FL | N | 207W00000X | ME126880 | FL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.