Healthcare Provider Details

I. General information

NPI: 1417900432
Provider Name (Legal Business Name): DELORES KAY WHITE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10495 N FLORIDA AVE
CITRUS SPRINGS FL
34434-3268
US

IV. Provider business mailing address

10495 N FLORIDA AVE
CITRUS SPRINGS FL
34434-3268
US

V. Phone/Fax

Practice location:
  • Phone: 352-465-5663
  • Fax: 352-465-5664
Mailing address:
  • Phone: 352-465-5663
  • Fax: 352-465-5664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS8341
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: