Provider Demographics
NPI:1962763649
Name:WHITE, MATAN (MD)
Entity type:Individual
Prefix:
First Name:MATAN
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 FOREST LN STE 218
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2783
Mailing Address - Country:US
Mailing Address - Phone:469-444-7760
Mailing Address - Fax:
Practice Address - Street 1:5925 FOREST LN STE 218
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2783
Practice Address - Country:US
Practice Address - Phone:469-444-7760
Practice Address - Fax:715-248-8073
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ78102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry