# DR. BRONSON B WHITE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1245316280
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | A 1121-99 | NM | Yes |

## Other

- **Enumeration date:** 10/31/2006
- **Last updated:** 08/30/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000K3526 | — | NM |
| 01 | — | HSZ196 | MEDICARE PART B | NM |