Provider Demographics
NPI:1215051818
Name:WATHERS, J. DON (MD)
Entity type:Individual
Prefix:
First Name:J.
Middle Name:DON
Last Name:WATHERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8697
Mailing Address - Country:US
Mailing Address - Phone:956-428-9652
Mailing Address - Fax:
Practice Address - Street 1:1401 S RANGERVILLE RD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-7638
Practice Address - Country:US
Practice Address - Phone:956-364-8456
Practice Address - Fax:956-364-8497
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG25092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG2509OtherMD LIC