Individual
STANLEY J WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
1673 SHORELINE DR, STE 100, BOISE, ID 83702-6736
(208) 322-0485
(208) 378-8228
Mailing address
1673 SHORELINE DR, STE 100, BOISE, ID 83702-6736
(208) 322-0485
(208) 378-8228
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M6247
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010004618
BLUE SHIELD PROVIDER #
ID
05
—
000039400
—
ID
01
—
71928
BLUE CROSS PROVIDER #
ID
Enumeration date
05/05/2006
Last updated
05/05/2015
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us