Individual
MR. JONATHON WAYNE WAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
159 TROUT AVE, GROTON, CT 06349
(860) 694-2876
Mailing address
38 CHERRY CIR, GROTON, CT 06340-3143
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/15/2012
Last updated
05/15/2012
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