Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 01033831 | IN |
NPI | 1376553099 |
---|---|
Provider Name | Dr. Steven M Waters |
First Address | Richmond, IN 47374-1212 |
Second Address | Richmond, IN 47374-1212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100352860 | (05) | IN |
E05871 | (02) | IN |