Provider Demographics
NPI:1750497434
Name:WATTS, MAUREEN WOOTEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:WOOTEN
Last Name:WATTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:PATRICE
Other - Last Name:WOOTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8330 MEADOW RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3767
Mailing Address - Country:US
Mailing Address - Phone:214-379-1100
Mailing Address - Fax:214-379-1101
Practice Address - Street 1:9101 N CENTRAL EXPY STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-6009
Practice Address - Country:US
Practice Address - Phone:214-820-9272
Practice Address - Fax:214-820-9003
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH78522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142094502Medicaid
TX142094501Medicaid
TX8K0768Medicare PIN
TX142094501Medicaid
TX142094501Medicaid