Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 9701192 | NC |
Y | 208600000X | Surgeon | 9701192 | NC |
NPI | 1003893629 |
---|---|
Provider Name | Gregory Stiegler Waters |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2005 |
Last Update Date | 12/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1055V | BCBS (01) | |
1802845000 | (05) | WV |
20052072 | RR MEDICARE (01) | |
21327 | PARTNERS (01) | |
7309392 | (05) | VA |
73369 | MEDCOST (01) | |
7852406 | AETNA (01) | |
891055V | (05) | NC |
G47642 | (02) | |
Q0119D | (05) | SC |