Provider Demographics
NPI:1609969443
Name:WHITE, DAVID E (PAC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:WHITE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 COUNTRY CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815-5830
Mailing Address - Country:US
Mailing Address - Phone:775-750-7159
Mailing Address - Fax:
Practice Address - Street 1:250 COUNTRY CLUB PKWY
Practice Address - Street 2:
Practice Address - City:SPRING CREEK
Practice Address - State:NV
Practice Address - Zip Code:89815
Practice Address - Country:US
Practice Address - Phone:775-750-7159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID363AMO700X363AM0700X
NVPA1661363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807568600Medicaid