Individual
JACOB WATTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2700 NW STEWART PKWY, ROSEBURG, OR 97471-1281
(541) 673-0611
Mailing address
2971 INTERSTATE AVE, ARCO, ID 83213-8705
(801) 367-5004
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA201167
OR
Other
Enumeration date
09/01/2020
Last updated
10/01/2020
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