Individual
DR. ANDREW KYLE WATTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
601 W 2ND ST, BLOOMINGTON, IN 47403-2317
(812) 353-9515
Mailing address
PO BOX 1329, BLOOMINGTON, IN 47402-1329
(812) 353-2154
(812) 353-5228
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01063914A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200868430
—
IN
Enumeration date
03/20/2007
Last updated
05/02/2014
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