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NPI Code Detail

MEDICARE: MR. JEFFREY A WATERS PA-C

MEDICARE: MR. JEFFREY A WATERS PA-C
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
1363A00000XPhysician Assistant909CO

Other Identifiers

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

General Provider Information

NPI Number : 1326010174
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY A WATERS PA-C
Provider Business Mailing Address
First Line : 2695 ROCKY MOUNTAIN AVE STE 150
Second Line :
City : LOVELAND
State : CO
Zip : 80538-9071
Country : US
Telephone Number : 719-630-6440
Fax Number : 719-228-6609
Provider Business Practice Location Address
First Line : 320 E FONTANERO ST STE 100
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-7535
Country : US
Telephone Number : 719-365-7420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2006
Last Update Date : 08/03/2021

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