Provider Demographics
NPI:1396029112
Name:WHITE, MARVIN CURTIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:CURTIS
Last Name:WHITE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1201 CAMINO DE SALUD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-4517
Mailing Address - Country:US
Mailing Address - Phone:505-925-0107
Mailing Address - Fax:505-925-0274
Practice Address - Street 1:1600 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7287
Practice Address - Country:US
Practice Address - Phone:575-538-2981
Practice Address - Fax:575-388-3373
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2011-0037363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM91470773Medicaid
NM91470773Medicaid