Individual
MR. JAY RUSSELL WAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
4755 PASTURE RD, FALLON, NV 89496-5000
(775) 426-3130
(775) 426-3133
Mailing address
733 ORCHARD DR APT A, FALLON, NV 89406-6158
(775) 426-3130
(775) 426-3133
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
01/31/2007
Last updated
07/08/2007
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