Provider Demographics
NPI:1902992290
Name:WHITE, KALVIN L (DO)
Entity Type:Individual
Prefix:
First Name:KALVIN
Middle Name:L
Last Name:WHITE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6802 S OLYMPIA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1823
Mailing Address - Country:US
Mailing Address - Phone:918-447-9300
Mailing Address - Fax:918-447-9308
Practice Address - Street 1:6802 S OLYMPIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1823
Practice Address - Country:US
Practice Address - Phone:918-447-9300
Practice Address - Fax:918-447-9308
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4497207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200108000AMedicaid
OKP00381429OtherRAILROAD MEDICARE
OK249711402Medicare PIN
OKP00381429OtherRAILROAD MEDICARE