Doctor Name: | DR. JASON WAITE |
NPI Number: | 1073950440 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPM |
License Number: | 0000729 |
Business Practice Address: | 575 Rivergate Unit 95 Durango, CO - 813017490 |
Business Phone Number: | 9702595303 |
Business Fax Number: | |
Mailing Address: | 575 Rivergate Unit 95, DURANGO |
State: | CO |
Postal Code: | 813017490 |
Phone Number: | 9702595303 |
Fax Number: | |
NPI Enumeration Date: | 05/25/2013 |
NPI Last Update Date: | 05/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213EP1101X |
License Number: | 0000729 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CO |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Primary Podiatric Medicine |
Taxonomy Definition: |