Provider Demographics
NPI:1588728331
Name:WHITE, MARSHALL W (MD)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:W
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:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-0576
Mailing Address - Country:US
Mailing Address - Phone:406-363-4602
Mailing Address - Fax:406-363-4604
Practice Address - Street 1:1019 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2333
Practice Address - Country:US
Practice Address - Phone:406-363-4602
Practice Address - Fax:406-363-4604
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6507207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0081090Medicaid
MT0081090Medicaid