Individual
JERRY DEE WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2721 OLIVE HWY, STE 9, OROVILLE, CA 95966-6115
(530) 538-3020
(530) 533-4243
Mailing address
236 W EAST AVE, PMB 323, CHICO, CA 95926-7235
(530) 538-3020
(530) 533-4243
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
G44051
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G440510
—
CA
01
—
P00084218
RAILROAD MEDICARE RRM
—
01
—
P00276055
MEDICARE RAILROAD #
—
Enumeration date
08/02/2006
Last updated
01/27/2012
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