Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0000729 | CO |
Y | 222Z00000X | Podiatrist | 0000729 | CO |
N | 213EP1101X | Primary Podiatric Medicine | 0000729 | CO |
N | 213ES0103X | Foot & Ankle Surgery | 0000729 | CO |
NPI | 1073950440 |
---|---|
Provider Name | Dr. Jason Waite |
First Address | Gunnison, UT 84634-0702 |
Second Address | Gunnison, UT 84634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2013 |
Last Update Date | 27/09/2018 |