Provider Demographics
NPI:1316987639
Name:WHITE, CHRISTOPHER LUKE (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LUKE
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 1:268 E CHICKASAW PKWY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-2538
Mailing Address - Country:US
Mailing Address - Phone:901-755-9905
Mailing Address - Fax:901-755-9982
Practice Address - Street 1:2911 BRUNSWICK RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-4105
Practice Address - Country:US
Practice Address - Phone:901-377-4722
Practice Address - Fax:901-373-0984
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000036971208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD0000036971OtherMEDICAL LICENSE