Provider Demographics
NPI:1073502142
Name:WHITE, DORA ELENA (MDPA)
Entity Type:Individual
Prefix:DR
First Name:DORA
Middle Name:ELENA
Last Name:WHITE
Suffix:
Gender:F
Credentials:MDPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9917 E BELL RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2397
Mailing Address - Country:US
Mailing Address - Phone:480-473-8866
Mailing Address - Fax:480-473-8875
Practice Address - Street 1:9917 E BELL RD STE 130
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2398
Practice Address - Country:US
Practice Address - Phone:480-473-8866
Practice Address - Fax:480-473-8875
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81634207R00000X
AZ10194207R00000X
HI4617207R00000X
CAA31720207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D37834Medicare UPIN
01777Medicare ID - Type Unspecified
AZZ111079Medicare PIN