MEDICARE: MORGAN WHITE RD

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	133V00000X	Registered Dietitian	DT83090	TX

General Provider Information

NPI Number	:	1720414360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN WHITE RD

Provider Business Mailing Address
First Line	:	2213 DRAKE FALLS DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-1761
Country	:	US
Telephone Number	:	303-653-1392
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 DRAKE FALLS DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-1761
Country	:	US
Telephone Number	:	303-653-1392
Fax Number	:

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

Provider Enumeration Date	:	09/14/2013
Last Update Date	:	07/18/2023

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