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General NPI Number Information
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NPI Number | 1326010174
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Entity Type | Individual
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Provider Name | JEFFREY A WATERS PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 320 E FONTANERO ST STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-7535
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Country | US
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Telephone | 719-365-7420
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Fax |
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Provider Business Mailing Address
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Address Line | 2695 ROCKY MOUNTAIN AVE STE 150
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City | LOVELAND
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State | CO
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Zip | 80538-9071
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Country | US
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Telephone | 719-630-6440
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Fax | 719-228-6609
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 909
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License Number State | CO
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