Provider Demographics
NPI:1558348474
Name:WHITE, PHILIP HAYDEN (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:HAYDEN
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 1518
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-1518
Mailing Address - Country:US
Mailing Address - Phone:903-243-4185
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:800-849-3597
Practice Address - Fax:903-885-4916
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2990207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115501202Medicaid
TXC23385Medicare UPIN
TX115501202Medicaid