MEDICARE: MICHAEL DAVID WHITE

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	332B00000X	Durable Medical Equipment & Medical Supplies	1000897	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1000897	OTHER	TX	STATE OF TEXAS DEVICE DISTRIBUTOR
2	616797400	OTHER		DEPARTMENT OF LABOR PROVIDER

General Provider Information

NPI Number	:	1609122977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DAVID WHITE

Provider Business Mailing Address
First Line	:	2707 N STEMMONS FWY
Second Line	:	SUITE # 245
City	:	DALLAS
State	:	TX
Zip	:	75207-2281
Country	:	US
Telephone Number	:	855-366-3635
Fax Number	:	855-633-3635

Provider Business Practice Location Address
First Line	:	2707 N STEMMONS FWY
Second Line	:	SUITE # 245
City	:	DALLAS
State	:	TX
Zip	:	75207-2281
Country	:	US
Telephone Number	:	855-366-3635
Fax Number	:	855-633-3635

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

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	07/24/2012

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Directions to “ MICHAEL DAVID WHITE ” Practice Location

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