Provider Demographics
NPI:1548688203
Name:WAITARA, MAGARYA STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:MAGARYA
Middle Name:STEPHEN
Last Name:WAITARA
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 1:4301 GARTH RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3153
Mailing Address - Country:US
Mailing Address - Phone:346-292-1470
Mailing Address - Fax:346-292-1471
Practice Address - Street 1:4301 GARTH RD STE 303
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3158
Practice Address - Country:US
Practice Address - Phone:346-292-1470
Practice Address - Fax:346-292-1471
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND15490208600000X
390200000X
TXT7764208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program