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General NPI Number Information
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NPI Number | 1184626350
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Entity Type | Organization
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Legal Business Name | PIEDMONT UROLOGY ASSOCIATES PA
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 924 COX RD
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City | GASTONIA
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State | NC
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Zip | 28054-3456
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Country | US
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Telephone | 704-869-0075
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Fax | 704-869-8875
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Provider Business Mailing Address
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Address Line | 924 COX RD
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City | GASTONIA
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State | NC
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Zip | 28054-3456
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Country | US
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Telephone | 704-869-0075
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Fax | 704-869-8875
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT L WATERHOUSE JR.
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Credential | M.D.
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Telephone | 704-869-0075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 0099-01352
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License Number State | NC
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