1750497434 NPI number — DR. MAUREEN WOOTEN WATTS MD

Table of content: DR. MAUREEN WOOTEN WATTS MD (NPI 1750497434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750497434 NPI number — DR. MAUREEN WOOTEN WATTS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATTS
Provider First Name:
MAUREEN
Provider Middle Name:
WOOTEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOOTEN
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
PATRICE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750497434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8330 MEADOW RD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75231-3767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-379-1100
Provider Business Mailing Address Fax Number:
214-379-1101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9101 N CENTRAL EXPY STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75231-6009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-820-9272
Provider Business Practice Location Address Fax Number:
214-820-9003
Provider Enumeration Date:
08/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  H7852 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 142094502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 142094501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".