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Individual

DR. JUSTIN ROBERT WATERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1304 FAWCETT AVE STE 100, TACOMA, WA 98402-1900
(253) 761-4200
(253) 761-4201
Mailing address
PO BOX 1535, TACOMA, WA 98401-1535
(253) 761-4200
(253) 383-3553

Taxonomy

Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
MD165195
OR
2085N0700X
Neuroradiology Physician
MD60344894
WA
2085R0202X
Diagnostic Radiology Physician
MD165195
OR
2085R0202X
Diagnostic Radiology Physician
Primary
MD60344894
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2028591
WA
05
500671344
OR
Enumeration date
07/16/2007
Last updated
09/03/2024
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