Provider Demographics
NPI:1689603284
Name:WATERMAN, DAVID G (MD)
Entity Type:Individual
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First Name:DAVID
Middle Name:G
Last Name:WATERMAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1300 N 500 E
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2408
Mailing Address - Country:US
Mailing Address - Phone:435-752-7445
Mailing Address - Fax:435-753-3059
Practice Address - Street 1:1300 N 500 E
Practice Address - Street 2:SUITE 350
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2408
Practice Address - Country:US
Practice Address - Phone:435-752-7445
Practice Address - Fax:435-753-3059
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-03-28
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Provider Licenses
StateLicense IDTaxonomies
UT363225-1205/8905207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG75540Medicare UPIN