Provider Demographics
NPI:1497788392
Name:WATERMAN, ROBERT WILLIAM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:WATERMAN
Suffix:JR
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 1:2500 OVERLOOK TERR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2286
Mailing Address - Country:US
Mailing Address - Phone:608-280-7084
Mailing Address - Fax:608-280-7203
Practice Address - Street 1:2500 OVERLOOK TERRACE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2286
Practice Address - Country:US
Practice Address - Phone:608-280-7084
Practice Address - Fax:608-280-7203
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI292322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32140200Medicaid
WI15955Medicare ID - Type Unspecified
WIG06974Medicare UPIN