Individual
BEVERLY L WADDLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
108 PARKER ST, STE.300, QUITMAN, TX 75783-2102
(903) 763-6220
(903) 763-6222
Mailing address
PO BOX 9477, TYLER, TX 75711-9477
(903) 594-2450
(903) 509-0493
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G0244
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120495005
—
TX
01
—
P00222535
MEDICARE RR
—
Enumeration date
06/23/2006
Last updated
06/03/2011
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