MR. Jay Russell Waite, IDC

NPI #1114064789 in Fallon, Nevada

Provider Information

NPI Number: 1114064789
Entity Type: Individual
Name: MR. Jay Russell Waite, IDC
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Military Health Care Provider - Independent Duty Corpsman
Credential: IDC
Enumeration Date: Jan 31, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 4755 PASTURE RD
City: Fallon
State: Nevada
ZIP Code: 89496-5000
Phone: (775) 426-3130

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Military Health Care Provider - Independent Duty Corpsman — Independent Duty Corpsman	1710I1002X	Primary

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