Provider Demographics
NPI:1982782108
Name:WHITE, CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:WHITE
Suffix:
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 1:9943 HICKMAN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-5304
Mailing Address - Country:US
Mailing Address - Phone:515-248-1447
Mailing Address - Fax:
Practice Address - Street 1:250 LAUREL ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3024
Practice Address - Country:US
Practice Address - Phone:515-643-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24945207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA46922OtherWELLMARK OF IOWA
IAIA0161OtherJOHN DEERE
IA3247197Medicaid
IA18763OtherMIDLANDS CHOICE
IA46922OtherWELLMARK OF IOWA
IAA14547Medicare UPIN