Daniel John Wattendorf, M.D.

Primary specialty

Clinical Cytogenetics PhysicianTaxonomy code 207SC0300X

License

MD067656L Issued in PA

Practice address

301 Fisher St
RM 1A132
Keesler AFB, MS 39534-2159

Phone

(228) 377-6393

Fax

(228) 377-6304

NPI assigned

Jul 28, 2006

Last updated

Sep 11, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1760496178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 FISHER ST",
            "address_2": "RM 1A132",
            "city": "KEESLER AFB",
            "state": "MS",
            "postal_code": "395342159",
            "telephone_number": "228-377-6393",
            "fax_number": "228-377-6304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 FISHER ST",
            "address_2": "RM 1A132",
            "city": "KEESLER AFB",
            "state": "MS",
            "postal_code": "395342159",
            "telephone_number": "228-377-6393",
            "fax_number": "228-377-6304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATTENDORF",
        "first_name": "DANIEL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD067656L",
            "primary": false
        },
        {
            "code": "207SC0300X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Cytogenetics",
            "state": "PA",
            "license": "MD067656L",
            "primary": true
        },
        {
            "code": "207SG0201X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": "PA",
            "license": "MD067656L",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Norbert Wajdowicz, DDS
• John Waldron, MD
• Benjamin Mark Watson, MD
• James Matthew Watson, MD
• John Devin Blackwell Watson, M.D.
• James Kevin Webb, CRNA
• Kimberly Weber
• Kathryn W. Weiss, CRNA
• Kathryn Welch, MCN, RDN, LD
• Stuart Weston, MD

• Clinical Cytogenetics Physician in Keesler AFB, MS
• Providers in Keesler AFB, MS by specialty
• Clinical Cytogenetics Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.

Verify at the official NPI Registry.