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NPI Code Detail

MEDICARE: PAUL A WATERS MD

MEDICARE: PAUL A 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
1207Q00000XFamily Medicine PhysicianC23567CA

General Provider Information

NPI Number : 1730191065
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL A WATERS MD
Provider Business Mailing Address
First Line : 3400 DATA DR
Second Line :
City : RANCHO CORDOVA
State : CA
Zip : 95670-7956
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 782 E HARDING WAY
Second Line :
City : STOCKTON
State : CA
Zip : 95204-6101
Country : US
Telephone Number : 209-475-5500
Fax Number : 209-466-1982
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2006
Last Update Date : 12/01/2014

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