Provider Demographics
NPI:1750327409
Name:WHITE, DEZRA (MD)
Entity Type:Individual
Prefix:
First Name:DEZRA
Middle Name:
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 1:2101 CRAWFORD ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8942
Mailing Address - Country:US
Mailing Address - Phone:713-659-5010
Mailing Address - Fax:713-659-5180
Practice Address - Street 1:2101 CRAWFORD ST
Practice Address - Street 2:SUITE 312
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8942
Practice Address - Country:US
Practice Address - Phone:713-659-5010
Practice Address - Fax:713-659-5180
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5247207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC0084448OtherDPS NUMBER
TXD5247OtherLICENSE NUMBER
0092HBOtherBCBS NUMBER
BW3546491OtherDEA NUMBER
C23391Medicare UPIN
TXD5247OtherLICENSE NUMBER