Provider Demographics
NPI:1639187271
Name:WATERMAN II, PHILIP F II (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:F
Last Name:WATERMAN II
Suffix:II
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 1:650 DEL PRADO BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-5617
Mailing Address - Country:US
Mailing Address - Phone:239-574-8200
Mailing Address - Fax:239-574-8928
Practice Address - Street 1:650 DEL PRADO BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-5617
Practice Address - Country:US
Practice Address - Phone:239-574-8200
Practice Address - Fax:239-574-8928
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 0033129207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54444Medicare UPIN
FL36242Medicare ID - Type Unspecified