Provider Demographics
NPI:1417975798
Name:WHITE, CLARA CATHERINE (DO)
Entity Type:Individual
Prefix:DR
First Name:CLARA
Middle Name:CATHERINE
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 1:608 ROSEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-9487
Mailing Address - Country:US
Mailing Address - Phone:816-331-5786
Mailing Address - Fax:
Practice Address - Street 1:403 BURKARTH ROAD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093
Practice Address - Country:US
Practice Address - Phone:816-561-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36137207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO243926813Medicaid
KS100234770CMedicaid
KS100234770CMedicaid
E25439Medicare UPIN