MEDICARE: DR. THOMAS D WHITE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	G0283	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0029BQ	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396788857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS D WHITE MD

Provider Business Mailing Address
First Line	:	6451 BRENTWOOD STAIR RD
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76112-3200
Country	:	US
Telephone Number	:	817-496-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	6451 BRENTWOOD STAIR RD
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76112-3200
Country	:	US
Telephone Number	:	817-496-9700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	03/03/2014

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