Provider Demographics
NPI:1336542182
Name:WHITE, GARY MICHAEL
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:MICHAEL
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 E WILLIAM ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-4056
Mailing Address - Country:US
Mailing Address - Phone:775-246-1444
Mailing Address - Fax:775-546-6156
Practice Address - Street 1:777 E WILLIAM ST
Practice Address - Street 2:SUITE 210
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-4056
Practice Address - Country:US
Practice Address - Phone:775-246-1444
Practice Address - Fax:775-546-6156
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies