Healthcare Provider Details

I. General information

NPI: 1508808122
Provider Name (Legal Business Name): DAVID DOUGLAS WATERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVENUE RM 5G1
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

PO BOX 7464
SAN FRANCISCO CA
94120-7464
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-3503
  • Fax: 415-206-5100
Mailing address:
  • Phone: 415-206-3103
  • Fax: 415-206-3872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC50282
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC50282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: