Provider Demographics
NPI:1548247075
Name:WHITE, DAVID K (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
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 269
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-0031
Mailing Address - Country:US
Mailing Address - Phone:503-684-1962
Mailing Address - Fax:503-624-9538
Practice Address - Street 1:14523 WESTLAKE DR
Practice Address - Street 2:SUITE 8
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7700
Practice Address - Country:US
Practice Address - Phone:503-684-1962
Practice Address - Fax:503-624-9538
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR194042084P0800X, 2084P0804X
WAMD0000362702084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1119437Medicaid
OR164993OtherOMAP
WA1119437Medicaid
OR117908Medicare ID - Type Unspecified