Provider Demographics
NPI:1043588833
Name:WATERS, JOHNATHAN SEAMUS (RT (R) CT)
Entity Type:Individual
Prefix:MR
First Name:JOHNATHAN
Middle Name:SEAMUS
Last Name:WATERS
Suffix:
Gender:M
Credentials:RT (R) CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 432
Mailing Address - Street 2:
Mailing Address - City:SELIGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2223 DANIEL ROAD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81006
Practice Address - Country:US
Practice Address - Phone:360-850-2739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF640812471C3401X
AZCRT-126572471C3401X
WART600906792471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography