MEDICARE: KIMBERLY M WAASO D.O.

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	207P00000X	Emergency Medicine Physician	L6345	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8G4111	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1346225018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY M WAASO D.O.

Provider Business Mailing Address
First Line	:	13276 BROOKFIELD LN
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77302-3471
Country	:	US
Telephone Number	:	936-441-5322
Fax Number	:	281-784-1522

Provider Business Practice Location Address
First Line	:	22999 HIGHWAY 59 N
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77339-4438
Country	:	US
Telephone Number	:	281-348-1301
Fax Number	:	281-348-1328

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	02/15/2008

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Directions to “ KIMBERLY M WAASO D.O.” Practice Location

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