Provider Demographics
NPI:1609878248
Name:WHITE, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
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:P.O. BOX 23228
Mailing Address - Street 2:
Mailing Address - City:GLADE PARK
Mailing Address - State:CO
Mailing Address - Zip Code:81523
Mailing Address - Country:US
Mailing Address - Phone:970-628-6954
Mailing Address - Fax:970-233-7769
Practice Address - Street 1:610 25 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505
Practice Address - Country:US
Practice Address - Phone:970-628-6954
Practice Address - Fax:970-233-7769
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8495885-1205207V00000X
CODR.0052262207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906622Medicaid
NC2041904Medicare UPIN