Provider Demographics
NPI:1245217082
Name:WHITE, LISA JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:JEAN
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:JEAN
Other - Last Name:WHITE-KIRLANGITIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0865
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:12222 MERIT DR STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-3294
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5660207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EH842OtherBCBS
TXP01446947OtherRR
050064762OtherRAILROAD
TX117007806Medicaid
TX8K5366Medicare PIN
TX89219KMedicare PIN
G32564Medicare UPIN
TX362390YK6UMedicare PIN
TXTXB110176Medicare PIN
TX84738KOtherBCBS
TX84738KMedicare PIN
TXTXB110300Medicare PIN