MEDICARE: MATAN 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
1	2084P0800X	Psychiatry Physician	Q7810	TX

General Provider Information

NPI Number	:	1962763649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATAN WHITE M.D.

Provider Business Mailing Address
First Line	:	5925 FOREST LN STE 218
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2783
Country	:	US
Telephone Number	:	469-444-7760
Fax Number	:

Provider Business Practice Location Address
First Line	:	5925 FOREST LN STE 218
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2783
Country	:	US
Telephone Number	:	469-444-7760
Fax Number	:	715-248-8073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	12/03/2020

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