Basic Information
| Provider Information | |||||||||
| NPI: | 1043536261 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATERS | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | WARD | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 449 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457500449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403744500 | ||||||||
| FaxNumber: | 7403745887 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 ANDERSON LN | ||||||||
| Address2: | |||||||||
| City: | WATERFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457865312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409842332 | ||||||||
| FaxNumber: | 7409844435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2010 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 34010331 | OH | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 34010331 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.