Provider Demographics
NPI:1174691034
Name:DOUGHTY WHITE, LINDA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ANN
Last Name:DOUGHTY WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 870458
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70187-0458
Mailing Address - Country:US
Mailing Address - Phone:504-494-6180
Mailing Address - Fax:504-243-1005
Practice Address - Street 1:4511 DOWNMAN RD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-3716
Practice Address - Country:US
Practice Address - Phone:504-245-4000
Practice Address - Fax:504-243-1005
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05400R2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1319619Medicaid
LA05400ROtherSTATE MEDICAL LICENSE