Healthcare Provider Details

I. General information

NPI: 1134528169
Provider Name (Legal Business Name): DONALD EDWARD WATENPAUGH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 COOPER ST
FORT WORTH TX
76104-2711
US

IV. Provider business mailing address

1521 COOPER ST
FORT WORTH TX
76104-2711
US

V. Phone/Fax

Practice location:
  • Phone: 817-332-7433
  • Fax: 817-336-2159
Mailing address:
  • Phone: 817-332-7433
  • Fax: 817-336-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: