Provider Demographics
NPI:1134212624
Name:WHITE, TONYA (MD)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE MMC 292
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-273-8700
Mailing Address - Fax:
Practice Address - Street 1:2312 SOUTH 6TH STREET
Practice Address - Street 2:F256 / 2B WEST
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-273-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44410208000000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1497542OtherARAZ
MNHP40918OtherHEALTHPARTNERS
MN15-65895OtherMEDICA - CHOICE
MN167403OtherUCARE
MN442103OtherFAIRVIEW
MN15-65895OtherMEDICA - PRIMARY
MN163A3WHOtherBLUE CROSS BLUE SHIELD
MN1029797OtherPREFERREDONE