MEDICARE: DR. MAUREEN WOOTEN WATTS 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
1	2084N0400X	Neurology Physician	H7852	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1750497434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAUREEN WOOTEN WATTS MD

Provider Business Mailing Address
First Line	:	8330 MEADOW RD
Second Line	:	SUITE 204
City	:	DALLAS
State	:	TX
Zip	:	75231-3767
Country	:	US
Telephone Number	:	214-379-1100
Fax Number	:	214-379-1101

Provider Business Practice Location Address
First Line	:	9101 N CENTRAL EXPY STE 400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-6009
Country	:	US
Telephone Number	:	214-820-9272
Fax Number	:	214-820-9003

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/03/2018

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