Healthcare Provider Details

I. General information

NPI: 1306922182
Provider Name (Legal Business Name): TRECIA L ELAHEE WHITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 COLLEGE PARK DR STE 104
CONROE TX
77384-4001
US

IV. Provider business mailing address

3115 COLLEGE PARK DR STE 104
CONROE TX
77384-4001
US

V. Phone/Fax

Practice location:
  • Phone: 936-321-5030
  • Fax: 936-271-5033
Mailing address:
  • Phone: 936-321-5030
  • Fax: 936-271-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK5520
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: