Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 347 | LA |
Y | 103TC0700X | Clinical Psychologist | 347 | LA |
N | 207RP1001X | Pulmonary Disease | 347 | LA |
NPI | 1053346908 |
---|---|
Provider Name | William Frederick Waters |
First Address | Baton Rouge, LA 70836-6455 |
Second Address | Baton Rouge, LA 70809-3726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 12/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1530760 | (05) | LA |
S41219 | (02) |