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General NPI Number Information
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NPI Number | 1225392160
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Entity Type | Individual
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Provider Name | THOMAS M. WATERBURY MD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | 4520 W 69TH ST
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City | SIOUX FALLS
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State | SD
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Zip | 57108-8148
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Country | US
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Telephone | 605-977-5000
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Fax | 605-977-5377
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Provider Business Mailing Address
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Address Line | 200 1ST ST SW
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City | ROCHESTER
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State | MN
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Zip | 55905-0001
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Country | US
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Telephone | 507-284-2511
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 56770
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 56770
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 56770
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 11389
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License Number State | SD
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