Provider Demographics
NPI:1346225018
Name:WAASO, KIMBERLY M (DO)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:WAASO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13276 BROOKFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302-3471
Mailing Address - Country:US
Mailing Address - Phone:936-441-5322
Mailing Address - Fax:281-784-1522
Practice Address - Street 1:22999 HIGHWAY 59 N
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77339-4438
Practice Address - Country:US
Practice Address - Phone:281-348-1301
Practice Address - Fax:281-348-1328
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6345207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G4111OtherBCBSTX
TXP00030459Medicare PIN
TXG97053Medicare UPIN
TX8A9275Medicare PIN
TX8A9121Medicare PIN
TXP00049670Medicare PIN