Individual
JOHN A WAITES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3800 S NATIONAL AVE STE 400, SPRINGFIELD, MO 65807-5272
(417) 875-3000
Mailing address
PO BOX 505673, SAINT LOUIS, MO 63150-5673
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
106992
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107090
BLUE CROSS/BLUE SHIELD
—
05
—
208056002
—
MO
Enumeration date
06/15/2006
Last updated
07/02/2024
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