Provider Demographics
NPI:1215327291
Name:STEPHEN K WATERBROOK MD INC
Entity type:Organization
Organization Name:STEPHEN K WATERBROOK MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WATERBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-272-2257
Mailing Address - Street 1:150 CATHERINE LN
Mailing Address - Street 2:SUITE J
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5719
Mailing Address - Country:US
Mailing Address - Phone:530-272-2257
Mailing Address - Fax:
Practice Address - Street 1:150 CATHERINE LN
Practice Address - Street 2:SUITE J
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5719
Practice Address - Country:US
Practice Address - Phone:530-272-2257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty