Provider Demographics
NPI:1801820998
Name:WHITE, THOMAS BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:BRIAN
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:PO BOX 1888
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403
Mailing Address - Country:US
Mailing Address - Phone:800-945-2455
Mailing Address - Fax:903-453-2541
Practice Address - Street 1:3000 HERRING AVENUE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708
Practice Address - Country:US
Practice Address - Phone:254-202-2000
Practice Address - Fax:254-753-6229
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL27492085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146884501Medicaid
TX146884502Medicaid
TX146884502Medicaid
TX86331RMedicare PIN
TX86680HMedicare PIN
TX300126304Medicare PIN
TX300125787Medicare PIN