Provider Demographics
NPI:1982110094
Name:JOHN GREGORY ATWATER MD PA
Entity Type:Organization
Organization Name:JOHN GREGORY ATWATER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:ATWATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-287-4621
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:772-213-9813
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:772-213-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119810207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME119810OtherDEPARTMENT OF HEALTH