Provider Demographics
NPI:1558564872
Name:WATERBROOK, STEPHEN KENTON (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KENTON
Last Name:WATERBROOK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:150 CATHERINE LN STE J
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5719
Mailing Address - Country:US
Mailing Address - Phone:530-269-8191
Mailing Address - Fax:530-205-9023
Practice Address - Street 1:150 CATHERINE LN
Practice Address - Street 2:SUITE J
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5719
Practice Address - Country:US
Practice Address - Phone:530-272-2257
Practice Address - Fax:530-272-6977
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2022-11-15
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Provider Licenses
StateLicense IDTaxonomies
CAA94355208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery