Provider Demographics
NPI:1932115656
Name:ATWATER, JOHN G (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:ATWATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1260 37TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6567
Mailing Address - Country:US
Mailing Address - Phone:772-213-9800
Mailing Address - Fax:772-213-9810
Practice Address - Street 1:1260 37TH ST STE 102
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6567
Practice Address - Country:US
Practice Address - Phone:772-213-9800
Practice Address - Fax:772-213-9810
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100906207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100906Medicaid
FL13031600Medicaid
ILH05638Medicare UPIN
FL13031600Medicaid