Provider Demographics
NPI:1174635452
Name:WHITE, LILLIAN RENEE (MD, PA)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:RENEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5068 W PLANO PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4408
Mailing Address - Country:US
Mailing Address - Phone:972-312-9292
Mailing Address - Fax:972-312-9995
Practice Address - Street 1:5068 W PLANO PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4408
Practice Address - Country:US
Practice Address - Phone:972-312-9292
Practice Address - Fax:972-312-9995
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0005GVOtherBLUE CROSS BLUE SHIELD
TXG86758Medicare UPIN
TX00640QMedicare ID - Type Unspecified