Healthcare Provider Details

I. General information

NPI: 1831195148
Provider Name (Legal Business Name): GARY W WHITE MD, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6124 W PARKER RD STE 436
PLANO TX
75093-8125
US

IV. Provider business mailing address

6124 W PARKER RD STE 436
PLANO TX
75093-8125
US

V. Phone/Fax

Practice location:
  • Phone: 972-608-3356
  • Fax: 972-608-3360
Mailing address:
  • Phone: 972-608-3356
  • Fax: 972-608-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE9009
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: