Provider Demographics
NPI:1689690174
Name:WHITE, LUCILE E (MD)
Entity Type:Individual
Prefix:
First Name:LUCILE
Middle Name:E
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 WEST LOOP SOUTH
Mailing Address - Street 2:SUITE #500
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401
Mailing Address - Country:US
Mailing Address - Phone:713-791-9966
Mailing Address - Fax:713-791-9927
Practice Address - Street 1:6700 WEST LOOP SOUTH
Practice Address - Street 2:SUITE #500
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401
Practice Address - Country:US
Practice Address - Phone:713-791-9966
Practice Address - Fax:713-791-9927
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7754207N00000X, 207ND0101X
IL036111738207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I33132Medicare UPIN