BRADLEY J. WATERMAN (NPI# 1699718809) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699718809 |
| Entity Type | Individual |
| Full Name | BRADLEY J. WATERMAN |
| Credential | M.D. |
| Practice Address |
1060 E 100 S Suite 110 Salt Lake City UT 84102-1501 |
| Practice Telephone | 8015319453 |
| Practice Fax Number | 8015319467 |
| Mailing Telephone | 8015319453 |
| Mailing Fax Number | 8015319467 |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2017-03-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 6602968-1205 | UT | Allopathic & Osteopathic Physicians |
| N | 208800000X | Urology | 46318 | WI | Allopathic & Osteopathic Physicians |
| Street Address |
1060 E 100 S SUITE 110 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84102-1501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548263213 | Lisa Stout | Specialist | 1060 E 100 S, Ste 110, Salt Lake City, UT 84102-1591 | 2005-05-24 |
| 1336686856 | Wasatch Psychological Services, LLC | Psychologist | 1060 E 100 S, Suite 100, Salt Lake City, UT 84102-1501 | 2017-01-23 |
| 1982083440 | Dr Amy Lynn Fehlberg | Psychologist | 1060 E 100 S, Ste 100, Salt Lake City, UT 84102-1582 | 2015-05-29 |
| 1386042760 | John Richard Mcvey | Physician Assistant | 1060 E 100 S, Suite 110, Salt Lake City, UT 84102-1501 | 2014-12-16 |
| 1275940611 | Sunnyside Pediatrics | Clinic/Center | 1060 E 100 S, #400, Salt Lake City, UT 84102-1501 | 2014-07-17 |
| 1164853651 | Garcia Clinical Psychology, LLC | Clinic/Center | 1060 E 100 S, Suite 100, Salt Lake City, UT 84102-1501 | 2013-12-09 |
| 1447522859 | Ryan Woodrow Wilkes | Psychologist | 1060 E 100 S, Suite 100, Salt Lake City, UT 84102-1501 | 2012-01-31 |
| 1912274309 | Julia Jacobs | Psychologist | 1060 E 100 S, Suite 100, Salt Lake City, UT 84102-1501 | 2011-11-29 |
| 1609167899 | Ryan Garcia | Psychologist | 1060 E 100 S, Suite 100, Salt Lake City, UT 84102-1501 | 2011-04-22 |
| 1225333842 | Wh-bm Consultant LLC | Specialist | 1060 E 100 S, L10, Salt Lake City, UT 84102-1501 | 2011-01-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942818604 | Wendy Vazquez | Behavior Technician | 515 S 700 E Suit 2a, Salt Lake City, UT 84102 | 2020-07-20 |
| 1407481245 | Odyssey House Inc | Family Medicine | 743 E 300 S, Salt Lake City, UT 84102 | 2020-03-11 |
| 1093359960 | Hayle Mayer | Behavior Technician | 515 S 700 E Salt Lake City, Suite 2a, Salt Lake, UT 84102 | 2019-11-04 |
| 1326680869 | Ronald Mcdonald House of The Intermountain Area | Meals | 935 E. South Temple, Salt Lake City, UT 84102 | 2019-10-16 |
| 1508419581 | Claire Pemberton | Behavior Technician | 327 E 1300 S, Apt 2, Salt Lake City, UT 84102 | 2019-07-19 |
| 1558923144 | Olivia Anne Hardwick | Social Worker | Transitions At Slrmc, 86 S. 1100 E. Suite 404, Salt Lake City, UT 84102 | 2019-07-03 |
| 1649741802 | Colten Vancampen | Behavior Technician | 515 S 700 E #2a, Salt Lake City, UT 84102 | 2018-12-16 |
| 1457847964 | Utah Podiatry Group PC | Podiatrist | 24 S 1100 E Ste 120, Salt Lake City, UT 84102 | 2018-07-09 |
| 1104311661 | Malorey Kooyman | Behavior Technician | 515 700 East, Suite 2a, Salt Lake City, UT 84102 | 2018-06-27 |
| 1700384930 | Utah Podiatry Group PC | Podiatrist | 82 S 1100 E Ste 301, Salt Lake City, UT 84102 | 2018-01-23 |
| Find all providers in zip 84102 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945061 | Utah Urology Works LLC | Urology | 4252 S Highland Dr Ste 200, Salt Lake City, UT 84124-2690 | 2020-06-05 |
| 1619402286 | Andrew Mazzone | Urology | University of Utah Som Division of Urology, 30 North 1900 East, Salt Lake City, UT 84132-0001 | 2017-04-20 |
| 1588195135 | Laurel S. Mast | Urology | 30 N 1900 E Rm 3b427, Salt Lake City, UT 84132-0002 | 2017-03-24 |
| 1588933527 | Hal H Bourne | Urology | 3250 Millcreek Dell Ln, Salt Lake City, UT 84109-3184 | 2011-12-20 |
| 1851627756 | Ned Legrande Mangelson | Urology | 2691 Roxbury Cir, Salt Lake City, UT 84108-2841 | 2009-10-27 |
| 1801067954 | Sara Marie Lenherr | Urology | 30 N 1900 E Rm 3b420, Salt Lake City, UT 84132-0002 | 2008-03-17 |
| 1982815718 | Stanford S. Putman | Urology | 324 10th Ave Ste 178, Salt Lake City, UT 84103-2885 | 2007-05-24 |
| 1346396959 | Jeremy Myers | Urology | University of Utah Division of Urology, 30 N 1900 E, Rm 3b420, Salt Lake City, UT 84132-0001 | 2007-01-26 |
| 1902364797 | Matthew S. Swallow | Urology | 30 N 1900 E Rm 3b427, Salt Lake City, UT 84132-0002 | 2019-03-11 |
| 1841757333 | Sharon P. Lo | Urology | 50 N Medical Dr, Salt Lake City, UT 84132-0001 | 2019-02-21 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84102 |
Please comment or provide details below to improve the information on BRADLEY J. WATERMAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.