Provider Demographics
NPI:1528350832
Name:DONALD R WATREN MD, PA
Entity type:Organization
Organization Name:DONALD R WATREN MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:WATREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-655-8990
Mailing Address - Street 1:1500 N DIXIE HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2712
Mailing Address - Country:US
Mailing Address - Phone:561-655-8990
Mailing Address - Fax:561-655-9684
Practice Address - Street 1:1500 N DIXIE HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2712
Practice Address - Country:US
Practice Address - Phone:561-655-8990
Practice Address - Fax:561-655-9684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63366261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA76309Medicare UPIN