Provider Demographics
NPI:1902848237
Name:DANIEL A WHITE PA
Entity Type:Organization
Organization Name:DANIEL A WHITE PA
Other - Org Name:GENERAL AND LAPAROENDOSCOPIC SURGEONS OF CENTRAL TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-242-5605
Mailing Address - Street 1:2 SAINT MARKS PL
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-1250
Mailing Address - Country:US
Mailing Address - Phone:979-242-5605
Mailing Address - Fax:979-242-5618
Practice Address - Street 1:2 SAINT MARKS PL
Practice Address - Street 2:SUITE 130
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-1250
Practice Address - Country:US
Practice Address - Phone:979-242-5605
Practice Address - Fax:979-242-5619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0826455-01Medicaid
TX00G07LMedicare ID - Type Unspecified