Provider Demographics
NPI:1255324968
Name:WATERFIELD, ROSS THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:THOMAS
Last Name:WATERFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 N CENTER RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-7920
Mailing Address - Country:US
Mailing Address - Phone:989-753-9000
Mailing Address - Fax:989-753-4024
Practice Address - Street 1:3400 N CENTER RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-7920
Practice Address - Country:US
Practice Address - Phone:989-753-9000
Practice Address - Fax:989-753-4024
Is Sole Proprietor?:No
Enumeration Date:2005-08-27
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC275042085R0202X
KY404002085R0202X
MI43010704582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000393392OtherBCBS
KY64126162Medicaid
KY64126162Medicaid
I63500Medicare PIN
KY0684428Medicare PIN
KY000000393392OtherBCBS
KY0903670Medicare PIN
KY0691699Medicare PIN