Healthcare Provider Details

I. General information

NPI: 1275536138
Provider Name (Legal Business Name): WILLIAM J. WATERHOUSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2478 PATTERSON RD # 7
GRAND JCT CO
81505-3605
US

IV. Provider business mailing address

2478 PATTERSON RD # 7
GRAND JCT CO
81505-3605
US

V. Phone/Fax

Practice location:
  • Phone: 970-255-7065
  • Fax: 970-255-7076
Mailing address:
  • Phone: 970-255-7065
  • Fax: 970-255-7076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number33513
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: