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NPI Code Detail

MEDICARE: DR. DOUGLAS WESLEY WHITE M.D.

MEDICARE: DR. DOUGLAS WESLEY WHITE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician01056740AIN
22085R0202XDiagnostic Radiology Physician13450NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21538140322OTHERNVANTHEM BCBS

General Provider Information

NPI Number : 1538140322
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOUGLAS WESLEY WHITE M.D.
Provider Business Mailing Address
First Line : PO BOX 463
Second Line :
City : AMARILLO
State : TX
Zip : 79105-0463
Country : US
Telephone Number : 866-750-3229
Fax Number : 766-752-2240
Provider Business Practice Location Address
First Line : 1409 E LAKE MEAD BLVD
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-7120
Country : US
Telephone Number : 866-750-3229
Fax Number : 866-752-2240
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2005
Last Update Date : 10/26/2010

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