Healthcare Provider Details

I. General information

NPI: 1821042441
Provider Name (Legal Business Name): BRUCE DAVID WHITE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 W THOMAS RD SUITE 240
PHOENIX AZ
85013-4405
US

IV. Provider business mailing address

3200 N CENTRAL AVE ST. 900
PHOENIX AZ
85012-2425
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-5199
  • Fax:
Mailing address:
  • Phone: 602-406-3729
  • Fax: 602-798-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3997
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: