Healthcare Provider Details

I. General information

NPI: 1417975798
Provider Name (Legal Business Name): CLARA CATHERINE WHITE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 BURKARTH ROAD
WARRENSBURG MO
64093
US

IV. Provider business mailing address

608 ROSEWOOD CIR
RAYMORE MO
64083-9487
US

V. Phone/Fax

Practice location:
  • Phone: 816-561-1025
  • Fax:
Mailing address:
  • Phone: 816-331-5786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number36137
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: