Provider Demographics
NPI:1609122977
Name:WHITE, MICHAEL DAVID
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 N STEMMONS FWY
Mailing Address - Street 2:SUITE # 245
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-2281
Mailing Address - Country:US
Mailing Address - Phone:855-366-3635
Mailing Address - Fax:855-633-3635
Practice Address - Street 1:2707 N STEMMONS FWY
Practice Address - Street 2:SUITE # 245
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-2281
Practice Address - Country:US
Practice Address - Phone:855-366-3635
Practice Address - Fax:855-633-3635
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000897332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1000897OtherSTATE OF TEXAS DEVICE DISTRIBUTOR
616797400OtherDEPARTMENT OF LABOR PROVIDER