Provider Demographics
NPI:1083667422
Name:WATERS, GREGORY J (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:WATERS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3333 EVERGREEN DR NE
Mailing Address - Street 2:ANESTHESIA MEDICAL CONSULTANTS
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9493
Mailing Address - Country:US
Mailing Address - Phone:616-364-4200
Mailing Address - Fax:616-364-7347
Practice Address - Street 1:3333 EVERGREEN DR NE
Practice Address - Street 2:ANESTHESIA MEDICAL CONSULTANTS
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9493
Practice Address - Country:US
Practice Address - Phone:616-364-4200
Practice Address - Fax:616-364-7347
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-07-03
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Provider Licenses
StateLicense IDTaxonomies
MI4301040936207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4876038Medicaid
MI4876038Medicaid
MIM71590-096Medicare PIN