Provider Demographics
NPI:1801867205
Name:WHITE, ROBERT F (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
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 1:416 KAUFMAN ST N
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:75457-2116
Mailing Address - Country:US
Mailing Address - Phone:903-537-3206
Mailing Address - Fax:903-537-2780
Practice Address - Street 1:416 KAUFMAN ST N
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:TX
Practice Address - Zip Code:75457-2116
Practice Address - Country:US
Practice Address - Phone:903-537-3206
Practice Address - Fax:903-537-2780
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC7159207P00000X, 208D00000X, 2083A0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139189809Medicaid
TX0077DTOtherBLUE CROSS BLUE SHIELD OF TEXAS
TX1801867205OtherNPI
TX0071BNOtherPTAN
TX1801867205OtherNPI
TXC23416Medicare UPIN