Provider Demographics
NPI:1033141684
Name:WHITE, FREDERICK A (MD)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:A
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2435
Mailing Address - Country:US
Mailing Address - Phone:325-677-5201
Mailing Address - Fax:325-677-3531
Practice Address - Street 1:2125 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2435
Practice Address - Country:US
Practice Address - Phone:325-677-5201
Practice Address - Fax:325-677-3531
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6207207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0914418-04Medicaid
TX0914418-04Medicaid
TXC23420Medicare UPIN