MEDICARE: DR. MELISSA ANN WATERS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	M8418	TX

General Provider Information

NPI Number	:	1366654758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA ANN WATERS M.D.

Provider Business Mailing Address
First Line	:	7859 WALNUT HILL LN STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-5605
Country	:	US
Telephone Number	:	214-369-7661
Fax Number	:

Provider Business Practice Location Address
First Line	:	7859 WALNUT HILL LN STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-5605
Country	:	US
Telephone Number	:	214-369-7661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2007
Last Update Date	:	09/06/2016

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