Individual
DERECK WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
1221 30TH ST SE, #25, AUBURN, WA 98002-8192
(206) 909-2693
Mailing address
1221 30TH ST SE, #25, AUBURN, WA 98002-8192
(206) 909-2693
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MA60272581
WA
Other
Enumeration date
03/27/2012
Last updated
03/27/2012
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