Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 7180 | CO |
N | 111NN1001X | Nutrition | 7180 | CO |
NPI | 1093968430 |
---|---|
Provider Name | Dr. Jarod Keith Waters |
First Address | Fountain, CO 80817-1742 |
Second Address | Fountain, CO 80817-1742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2008 |
Last Update Date | 09/08/2016 |