Healthcare Provider Details

I. General information

NPI: 1346539319
Provider Name (Legal Business Name): RICHARD CHRISTOPHER WATERS MD, MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 3RD AVE
SEATTLE WA
98104-2304
US

IV. Provider business mailing address

515 3RD AVE
SEATTLE WA
98104-2304
US

V. Phone/Fax

Practice location:
  • Phone: 206-776-2253
  • Fax: 206-895-4977
Mailing address:
  • Phone: 206-776-2253
  • Fax: 206-895-4977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD60479832
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: