Individual
MR. JEFFREY A WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
320 E FONTANERO ST STE 100, COLORADO SPRINGS, CO 80907-7535
(719) 365-7420
Mailing address
2695 ROCKY MOUNTAIN AVE STE 150, LOVELAND, CO 80538-9071
(719) 630-6440
(719) 228-6609
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
909
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61007765
—
CO
Enumeration date
02/06/2006
Last updated
08/03/2021
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