Healthcare Provider Details

I. General information

NPI: 1609969443
Provider Name (Legal Business Name): DAVID E WHITE PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 COUNTRY CLUB PKWY
SPRING CREEK NV
89815
US

IV. Provider business mailing address

250 COUNTRY CLUB PKWY
SPRING CREEK NV
89815-5830
US

V. Phone/Fax

Practice location:
  • Phone: 775-750-7159
  • Fax:
Mailing address:
  • Phone: 775-750-7159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number363AMO700X
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1661
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: