Provider Demographics
NPI:1841218674
Name:WHITE, DAVID K (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
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 1:2929 5TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7363
Mailing Address - Country:US
Mailing Address - Phone:605-721-1662
Mailing Address - Fax:605-721-8827
Practice Address - Street 1:2929 5TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7363
Practice Address - Country:US
Practice Address - Phone:605-721-1662
Practice Address - Fax:605-721-8827
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-85382085R0202X
SD72212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200335320AMedicaid
KY64038367Medicaid
OH2551840OtherAETNA
OH2205189Medicaid
OH4119695Medicare PIN
IN200335320AMedicaid
OHG90509Medicare UPIN
KY64038367Medicaid
OH2205189Medicaid
OH4211531Medicare PIN
OH4119694Medicare PIN
OH4119696Medicare PIN