Provider Demographics
NPI:1457612319
Name:WATERS, J ALAN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:ALAN
Last Name:WATERS
Suffix:JR
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 1:1330 BOREN AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2717
Mailing Address - Country:US
Mailing Address - Phone:210-310-8185
Mailing Address - Fax:
Practice Address - Street 1:747 BROADWAY, SUITE 739 WEST
Practice Address - Street 2:SWEDISH MEDICAL CENTER, GENERAL SURGERY PROGRAM
Practice Address - City:SEATTLE
Practice Address - State:TX
Practice Address - Zip Code:98101-4307
Practice Address - Country:US
Practice Address - Phone:206-386-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program