Provider Demographics
NPI:1194037754
Name:WAITE, KENNETH B (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:B
Last Name:WAITE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 BANNISTER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MCGREGOR
Mailing Address - State:TX
Mailing Address - Zip Code:76657
Mailing Address - Country:US
Mailing Address - Phone:949-326-6615
Mailing Address - Fax:
Practice Address - Street 1:8416 OLD MCGREGOR RD
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-6499
Practice Address - Country:US
Practice Address - Phone:254-307-3997
Practice Address - Fax:254-300-9935
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-11
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV4775207P00000X
VA39020000X207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine