Active NPI
Brian Michael Waters, MD
- Psychiatry Physician
- Lackland Afb, TX
National Provider Identifier
1154543684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 49112
- Practice address
- 2200 Bergquist Drive
Wilford Hall Medical Center
Lackland Afb, TX 78236-5300 - Phone
- (210) 292-7361
- NPI assigned
- May 3, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 49112 | WI | Primary |
Addresses
Primary practice location
2200 Bergquist Drive
Wilford Hall Medical Center
Lackland Afb, TX 78236-5300
Mailing address
8722 Melrose
San Antonio, TX 78250
Phone (210) 410-9757
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49112 | WI | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154543684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8722 MELROSE",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78250",
"telephone_number": "210-410-9757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 BERGQUIST DRIVE",
"address_2": "WILFORD HALL MEDICAL CENTER",
"city": "LACKLAND AFB",
"state": "TX",
"postal_code": "782365300",
"telephone_number": "210-292-7361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERS",
"first_name": "BRIAN",
"middle_name": "MICHAEL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WI",
"license": "49112",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lackland Afb, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.