Basic Information
| Provider Information | |||||||||
| NPI: | 1265449078 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAITS | ||||||||
| FirstName: | KERRY | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1425 MONTGOMERY RD | ||||||||
| Address2: | |||||||||
| City: | RED BLUFF | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960804605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305288600 | ||||||||
| FaxNumber: | 5305288612 | ||||||||
| Practice Location | |||||||||
| Address1: | 2550 SISTER MARY COLUMBA DR | ||||||||
| Address2: | |||||||||
| City: | RED BLUFF | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960804327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305298330 | ||||||||
| FaxNumber: | 5305298329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 07/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 20A8424 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.