Healthcare Provider Details

I. General information

NPI: 1295778801
Provider Name (Legal Business Name): DAVID C WATERSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 TURWILL LN
KALAMAZOO MI
49006-4231
US

IV. Provider business mailing address

601 JOHN STREET BOX 42
KALAMAZOO MI
49007
US

V. Phone/Fax

Practice location:
  • Phone: 269-343-8170
  • Fax: 269-382-8490
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number5101013019
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101013019
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: