Matthew William Waack, D.O.

Primary specialty

Aerospace Medicine PhysicianTaxonomy code 2083A0100X

License

K9928 Issued in TX

Practice address

12406 Stable Forest Dr
San Antonio, TX 78249-4614

Phone

(210) 690-5296

Fax

(210) 690-5296

NPI assigned

Jun 25, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740486992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12406 STABLE FOREST DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782494614",
            "telephone_number": "210-690-5296",
            "fax_number": "210-690-5296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12406 STABLE FOREST DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782494614",
            "telephone_number": "210-690-5296",
            "fax_number": "210-690-5296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAACK",
        "first_name": "MATTHEW",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "TX",
            "license": "K9928",
            "primary": true
        },
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "OK",
            "license": "2065",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Aerospace Medicine Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Aerospace Medicine Physician in Texas

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.