Provider Demographics
NPI:1760442024
Name:WATAHA, JOSEPH F (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:WATAHA
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 1:2754 COMPASS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8714
Mailing Address - Country:US
Mailing Address - Phone:970-254-1686
Mailing Address - Fax:970-254-1687
Practice Address - Street 1:2021 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2980
Practice Address - Country:US
Practice Address - Phone:970-242-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37529207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93105380Medicaid
UTT0189Medicaid
UTT0189Medicaid
C105128Medicare PIN