Provider Demographics
NPI:1285778381
Name:WHITE, DAVID HERMAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:HERMAN
Last Name:WHITE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 TAYLORS RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-8834
Mailing Address - Country:US
Mailing Address - Phone:254-773-7664
Mailing Address - Fax:
Practice Address - Street 1:2604 TAYLORS RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-8834
Practice Address - Country:US
Practice Address - Phone:254-773-7664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-137363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical