Provider Demographics
NPI:1174580476
Name:WHITE, RAE D (DO)
Entity type:Individual
Prefix:
First Name:RAE
Middle Name:D
Last Name:WHITE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5199
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5199
Mailing Address - Country:US
Mailing Address - Phone:325-437-8300
Mailing Address - Fax:325-437-8399
Practice Address - Street 1:1800 W CHESTNUT
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76203
Practice Address - Country:US
Practice Address - Phone:940-565-2333
Practice Address - Fax:940-565-3190
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9554207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E78157Medicare UPIN