Provider Demographics
NPI:1417900432
Name:WHITE, DELORES KAY (DO)
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:KAY
Last Name:WHITE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10495 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:CITRUS SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34434-3268
Mailing Address - Country:US
Mailing Address - Phone:352-465-5663
Mailing Address - Fax:352-465-5664
Practice Address - Street 1:10495 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:CITRUS SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34434-3268
Practice Address - Country:US
Practice Address - Phone:352-465-5663
Practice Address - Fax:352-465-5664
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8341207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58746OtherBCBSFL
FL261203800Medicaid
FL261203800Medicaid
FL58746ZMedicare PIN
FL58746XMedicare PIN