Provider Demographics
NPI:1710932850
Name:WHITE, KRISTIN C (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:C
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 1:1416 6TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-4818
Mailing Address - Country:US
Mailing Address - Phone:641-424-0102
Mailing Address - Fax:641-424-8059
Practice Address - Street 1:1010 4TH ST SW
Practice Address - Street 2:SUITE 100
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2857
Practice Address - Country:US
Practice Address - Phone:641-424-0102
Practice Address - Fax:641-424-8059
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA323642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1930289Medicaid
IA46018OtherWELLMARK BCBS OF IA
46018Medicare ID - Type Unspecified
G75240Medicare UPIN