Provider Demographics
NPI:1518945518
Name:WHITE, TRACI LENAE (MD)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LENAE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:851 LAKE CAROLYN PKWY
Mailing Address - Street 2:#370
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4100
Mailing Address - Country:US
Mailing Address - Phone:267-258-9084
Mailing Address - Fax:
Practice Address - Street 1:5445 LA SIERRA DR
Practice Address - Street 2:SUITE 203
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4139
Practice Address - Country:US
Practice Address - Phone:972-755-3037
Practice Address - Fax:972-755-3037
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL76012084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL7601OtherSTATE BOARD MEDICAL LICEN
TXL7601OtherSTATE BOARD MEDICAL LICEN