| Doctor Name: | MR. MICHAEL ALAN WATERS |
| NPI Number: | 1861469512 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LAT, ATC, CSCS |
| License Number: | AT0945 |
| Business Practice Address: | 309 S. Medford Dr. Lufkin, TX - 759015245 |
| Business Phone Number: | 9366327656 |
| Business Fax Number: | 9366341091 |
| Mailing Address: | 906 Willow Oak St, DIBOLL |
| State: | TX |
| Postal Code: | 759419773 |
| Phone Number: | 9368294798 |
| Fax Number: | |
| NPI Enumeration Date: | 03/01/2006 |
| NPI Last Update Date: | 04/16/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | AT0945 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |