Individual
DR. HARRIS JOHN WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
450 WELCH ST, SILVERTON, OR 97381-1934
(503) 873-5310
(503) 873-5315
Mailing address
450 WELCH ST, SILVERTON, OR 97381-1934
(503) 873-5310
(503) 873-5315
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD15831
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
082755
—
OR
01
—
109896
MEDICARE PTIN
OR
Enumeration date
09/28/2005
Last updated
05/26/2010
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