Waters, Stanley J

Waters, Stanley J is an sole proprietor health care provider with primary practice located at 1673 Shoreline Dr Ste 100, Boise ID 83702-6736. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Waters, Stanley J can be contacted via phone (208) 322-0485.

Contact Information

Primary practice address
1673 Shoreline Dr Ste 100 Boise ID 83702-6736
Phone: (208) 322-0485
Fax: (208) 378-8228
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X M6247 Idaho

Profile Details

NPI number 1821046335
LBN Legal business name Waters, Stanley J
Credentials M.D., PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 5th, 2006
Last updated May 5th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821046335 NPPES
Idaho MEDICAID 000039400
Idaho Other 71928
Idaho Other 000010004618

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