Provider Demographics
NPI:1881683746
Name:WHITE, RODDY S (MD)
Entity Type:Individual
Prefix:DR
First Name:RODDY
Middle Name:S
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 1:1201 SADDLE LAKES DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602
Mailing Address - Country:US
Mailing Address - Phone:325-690-0162
Mailing Address - Fax:
Practice Address - Street 1:6250 HIGHWAY 83 84
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605
Practice Address - Country:US
Practice Address - Phone:325-428-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8835207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138731814Medicaid
TX138731814Medicaid
TX8A8415Medicare ID - Type Unspecified