Provider Demographics
NPI:1457389835
Name:WHITE, LAHROY ALWARD JR (MD)
Entity Type:Individual
Prefix:
First Name:LAHROY
Middle Name:ALWARD
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 MEDI PARK DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2111
Mailing Address - Country:US
Mailing Address - Phone:806-359-3193
Mailing Address - Fax:806-355-9533
Practice Address - Street 1:1920 MEDI PARK DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2111
Practice Address - Country:US
Practice Address - Phone:806-359-3193
Practice Address - Fax:806-355-9533
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1177207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00AM56Medicare ID - Type Unspecified
C23403Medicare UPIN