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General NPI Number Information
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NPI Number | 1396515078
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Entity Type | Individual
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Provider Name | BRIAN WHITE ATC/L, ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 01/04/2024
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 2600 W NEAL ST
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City | COMMERCE
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State | TX
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Zip | 75428-4311
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Country | US
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Telephone | 650-823-4929
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 W NEAL ST
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City | COMMERCE
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State | TX
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Zip | 75428-4311
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Country | US
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Telephone | 650-823-4929
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | AT9514
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License Number State | TX
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