Provider Demographics
NPI:1821666876
Name:WATERSON, DAVID CHARLES JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CHARLES
Last Name:WATERSON
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:8801 CEDAR GROVE LN APT 628
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-9813
Mailing Address - Country:US
Mailing Address - Phone:517-582-0849
Mailing Address - Fax:
Practice Address - Street 1:1400 MERCY DR STE 100
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1833
Practice Address - Country:US
Practice Address - Phone:231-733-1326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2022-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601010609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant