Provider Demographics
NPI:1538140322
Name:WHITE, DOUGLAS WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WESLEY
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105-0463
Mailing Address - Country:US
Mailing Address - Phone:866-750-3229
Mailing Address - Fax:766-752-2240
Practice Address - Street 1:1409 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7120
Practice Address - Country:US
Practice Address - Phone:866-750-3229
Practice Address - Fax:866-752-2240
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056740A2085R0202X
NV134502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1538140322Medicaid
NV1538140322OtherANTHEM BCBS
NV1538140322OtherANTHEM BCBS