Provider Demographics
NPI:1972171288
Name:REESE-WHITE, DEONNA RENEE (MD)
Entity Type:Individual
Prefix:
First Name:DEONNA
Middle Name:RENEE
Last Name:REESE-WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NORTH I-35
Mailing Address - Street 2:CEC 310
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1966
Mailing Address - Country:US
Mailing Address - Phone:512-324-7890
Mailing Address - Fax:
Practice Address - Street 1:1400 NORTH I-35
Practice Address - Street 2:CEC 310
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1966
Practice Address - Country:US
Practice Address - Phone:512-324-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10076733390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program