Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | G2241 | TX |
Y | 2081S0010X | Sports Medicine | MD039557E | PA |
Y | 213ES0000X | Sports Medicine | MD039557E | PA |
NPI | 1073502639 |
---|---|
Provider Name | Deborah U Waters |
First Address | Shiprock, NM 87420-0160 |
Second Address | Shiprock, NM 87420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 26/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
432394 | (05) | AZ |
43280579 | (05) | CO |
C23198 | (02) | |
Q9896 | (05) | NM |