Provider Demographics
NPI:1457397283
Name:WHITE, RICHARD MAURICE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MAURICE
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:909 W MAGNOLIA AVE
Mailing Address - Street 2:SIUTE #4
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4571
Mailing Address - Country:US
Mailing Address - Phone:817-923-8223
Mailing Address - Fax:817-923-8590
Practice Address - Street 1:909 W MAGNOLIA AVE
Practice Address - Street 2:SIUTE #4
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4571
Practice Address - Country:US
Practice Address - Phone:817-923-8223
Practice Address - Fax:817-923-8590
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2244207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC23412Medicare UPIN