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NPI Code Detail

MEDICARE: JOSEPH L WATERS M.D.

MEDICARE:   JOSEPH L WATERS  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianM5829ID

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00189860OTHERIDRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578503926
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH L WATERS M.D.
Provider Business Mailing Address
First Line : PO BOX 587
Second Line :
City : TWIN FALLS
State : ID
Zip : 83303-0587
Country : US
Telephone Number : 208-814-7400
Fax Number : 208-814-7491
Provider Business Practice Location Address
First Line : 746 N COLLEGE RD
Second Line : SUITE A
City : TWIN FALLS
State : ID
Zip : 83301-3486
Country : US
Telephone Number : 208-814-7265
Fax Number : 208-814-7284
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2006
Last Update Date : 01/02/2015

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Directions to “ JOSEPH L WATERS M.D.” Practice Location

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