| Randall Glen White Jr, MD | |
|
2300 Hospital Dr Ste 120, Bossier City, LA 71111 | |
| (318) 212-7982 | |
| (318) 212-7989 |
| Full Name | Randall Glen White Jr |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 2300 Hospital Dr Ste 120, Bossier City, Louisiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295199016 | NPI | - | NPPES |
| 2417380 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 313083 (Louisiana) | Primary |
| Entity Name | Wk Preferred Pediatrics |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1760043491 PECOS PAC ID: 9931537974 Enrollment ID: O20200325001138 |
| Mailing Address | Practice Location Address |
|---|---|
| Randall Glen White Jr, MD 1202 Louisiana Ave, Shreveport, LA 71101-3910 Ph: (318) 212-8951 | Randall Glen White Jr, MD 2300 Hospital Dr Ste 120, Bossier City, LA 71111 Ph: (318) 212-7982 |
Manohar R. Manchandia, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2706 Shed Rd, Bossier City, LA 71111 Phone: 318-747-5272 Fax: 318-746-9669 | |
Dr. Zack G Sanders, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2400 Hospital Dr, Ste 120, Bossier City, LA 71111 Phone: 318-742-6710 Fax: 318-747-5393 | |
Quynh Tran Dang, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2300 Hospital Dr Ste 340, Bossier City, LA 71111 Phone: 318-212-7883 Fax: 318-212-7885 | |
Dr. Jacqueline J Gray, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2300 Hospital Dr Ste 420, Bossier City, LA 71111 Phone: 318-212-7880 | |
Jennifer Kelley, MD Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 5751 Shed Rd Ste 120, Bossier City, LA 71111 Phone: 318-935-1922 Fax: 318-935-1925 | |
Dr. Robert Borden Wilson, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 2300 Hospital Dr Ste 120, Bossier City, LA 71111 Phone: 318-212-7982 Fax: 318-212-7989 |