Provider Demographics
NPI:1194769513
Name:WHITE, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-233-2300
Mailing Address - Fax:580-548-1497
Practice Address - Street 1:24988 SE STARK ST STE 220
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8324
Practice Address - Country:US
Practice Address - Phone:503-674-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD218730207R00000X
OK19950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200442000Medicaid
KS200606660AMedicaid
OK100037900AMedicaid
IN000000287113OtherANTHEM PROVIDER #
IN100180890GMedicaid
INCH6490OtherGROUP IN RAILROAD MCR#
OK100037900AMedicaid
OKOK402797Medicare PIN
IN940280E1Medicare PIN
ING19083Medicare UPIN
INCH6490OtherGROUP IN RAILROAD MCR#
IN100180890GMedicaid
OKOK700683Medicare PIN