Healthcare Provider Details

I. General information

NPI: 1255836045
Provider Name (Legal Business Name): DARA C WHITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DARA CAMILLE WHITE MD

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 06/13/2021
Certification Date: 06/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC 10-5550 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

MSC10-5550 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4661
  • Fax: 505-272-4628
Mailing address:
  • Phone: 505-272-4661
  • Fax: 505-272-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2021-0305
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: