Healthcare Provider Details

I. General information

NPI: 1396029112
Provider Name (Legal Business Name): MARVIN CURTIS WHITE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E 32ND ST
SILVER CITY NM
88061-7287
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 575-538-2981
  • Fax: 575-388-3373
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2011-0037
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: