Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 5101013019 | MI |
Y | 207QS0010X | Family Doctor - Sports Medicine | 5101013019 | MI |
NPI | 1295778801 |
---|---|
Provider Name | Dr. David C Waterson |
First Address | East Lansing, MI 48823-5384 |
Second Address | Kalamazoo, MI 49006-4231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 25/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0153311575 | BLUE CARE NETWORK (01) | MI |
0153311575 | BLUE CROSS BLUE SHIELD (01) | MI |
0M21440047 | MEDICARE ADVANTAGE (01) | MI |
1022112 | MCLAREN HEALTH ADVANTAGE (01) | MI |
1022112 | MCLAREN HEALTH PLAN-COMMERCIAL (01) | MI |
1022112 | MCLAREN HEALTH PLAN-MEDICAID (01) | MI |
200000001163 | PHP (01) | MI |
200000001163 | PHP FAMILYCARE (01) | MI |
4844348 | (05) | MI |
7778363 | AETNA (01) | MI |
G92238 | (02) | MI |
P00357559 | RAILROAD MEDICARE (01) | MI |