Provider Demographics
NPI:1609985811
Name:VAWTER, ANNA B (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:B
Last Name:VAWTER
Suffix:
Gender:F
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 1019
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-0017
Mailing Address - Country:US
Mailing Address - Phone:972-954-5573
Mailing Address - Fax:
Practice Address - Street 1:788 S WATTERS RD STE 120
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5123
Practice Address - Country:US
Practice Address - Phone:972-649-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5593207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105267Medicaid
ILK09341Medicare ID - Type Unspecified
I08581Medicare UPIN
IL036105267Medicaid