Individual
JOSEPH L WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
746 N COLLEGE RD, SUITE A, TWIN FALLS, ID 83301-3486
(208) 814-7265
(208) 814-7284
Mailing address
PO BOX 587, TWIN FALLS, ID 83303-0587
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M5829
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004011100
—
ID
01
—
P00189860
RR MEDICARE
ID
Enumeration date
06/07/2006
Last updated
01/02/2015
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