Individual
DR. DANIEL JOHN WATTENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 FISHER ST, RM 1A132, KEESLER AFB, MS 39534-2159
(228) 377-6393
(228) 377-6304
Mailing address
301 FISHER ST, RM 1A132, KEESLER AFB, MS 39534-2159
(228) 377-6393
(228) 377-6304
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD067656L
PA
207SC0300X
Clinical Cytogenetics Physician
Primary
MD067656L
PA
207SG0201X
Clinical Genetics (M.D.) Physician
MD067656L
PA
Other
Enumeration date
07/28/2006
Last updated
09/11/2025
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