Provider Demographics
NPI:1760678627
Name:WATERMEIER, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WATERMEIER
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 1:3715 PRYTANIA ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3761
Mailing Address - Country:US
Mailing Address - Phone:504-895-2055
Mailing Address - Fax:504-896-3870
Practice Address - Street 1:3715 PRYTANIA ST
Practice Address - Street 2:SUITE 501
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3761
Practice Address - Country:US
Practice Address - Phone:504-895-2055
Practice Address - Fax:504-896-3870
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011880174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA011880OtherLA STATE BOARD MEDICAL EX