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NPI Code Detail

MEDICARE: DAN NEAL WATERS MD

MEDICARE: DAN NEAL WATERS MD
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
1207Q00000XFamily Medicine Physician14804OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750341012
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAN NEAL WATERS MD
Provider Business Mailing Address
First Line : 5721 NW 132ND ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-4437
Country : US
Telephone Number : 405-557-1200
Fax Number : 405-557-1977
Provider Business Practice Location Address
First Line : 5721 NW 132ND ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-4437
Country : US
Telephone Number : 405-557-1200
Fax Number : 405-557-1977
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 01/29/2024

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Directions to “ DAN NEAL WATERS MD” Practice Location

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