1265738744 NPI number — DONALD DAVID WHITE LCDC

Table of content: (NPI 1679218945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265738744 NPI number — DONALD DAVID WHITE LCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
DONALD
Provider Middle Name:
DAVID
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265738744
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4352 EMMETT F LOWRY EXPY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXAS CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77591-2628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-763-2373
Provider Business Mailing Address Fax Number:
409-948-1411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 ROSENBERG ST STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALVESTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77550-1494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-763-2373
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  8118 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)