Provider Demographics
NPI:1326033077
Name:WHITE, STEPHEN V (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:V
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:V
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1111 HIGHWAY 6
Mailing Address - Street 2:SUITE 145
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4914
Mailing Address - Country:US
Mailing Address - Phone:281-565-8333
Mailing Address - Fax:
Practice Address - Street 1:1111 HIGHWAY 6
Practice Address - Street 2:SUITE 145
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4914
Practice Address - Country:US
Practice Address - Phone:281-565-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7711174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87G697Medicare ID - Type Unspecified
TXC23394Medicare UPIN