Individual
STANLEY J WATERS
Active
Individual
STANLEY J WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
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
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