MEDICARE: JAMES D WATERS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	C7550	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053350066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES D WATERS MD

Provider Business Mailing Address
First Line	:	PO BOX 432
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72654-0432
Country	:	US
Telephone Number	:	870-424-7070
Fax Number	:	870-424-6616

Provider Business Practice Location Address
First Line	:	620 N MAIN ST
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-2911
Country	:	US
Telephone Number	:	870-414-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	04/28/2011

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