Individual
EDWIN C WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12455 E 100TH ST N, SUITE 120, OWASSO, OK 74055-4674
(918) 274-5510
(918) 274-5519
Mailing address
1515 N HARVARD AVE, SUITE E, TULSA, OK 74115-4957
(918) 832-6049
(918) 832-6055
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
115331
MO
207Q00000X
Family Medicine Physician
Primary
25302
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205336308
—
MO
Enumeration date
06/01/2006
Last updated
02/09/2011
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