Provider Demographics
NPI:1356301022
Name:WATERS, WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:WATERS
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 814129
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75381-4129
Mailing Address - Country:US
Mailing Address - Phone:972-906-6250
Mailing Address - Fax:972-906-0116
Practice Address - Street 1:102 DECKER CT
Practice Address - Street 2:SUITE 205
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-2740
Practice Address - Country:US
Practice Address - Phone:972-906-6250
Practice Address - Fax:972-906-0116
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF72862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117118303Medicaid
TX117118303Medicaid
E79505Medicare UPIN