Jude Thaddeus Waterbury (NPI# 1487626594, PAC ID# 2062468366) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is INTERNAL MEDICINE.
| Nation Provider ID (NPI) | 1487626594 |
| PAC ID by PECOS | 2062468366 |
| Professional Enrollment ID | I20051103001052 |
| Full Name | Jude Thaddeus Waterbury |
| Organization Legal Name | CIRCLE OF LIFE MEDICINE, INC |
| Address |
2382 Maritime Dr Suite 100 Elk Grove CA 95758-3659 |
| Phone Number | 9166916622 |
| Gender | M |
| Credential | MD |
| Graduation Year | 2000 |
| Primary Specialty | INTERNAL MEDICINE |
| Group Practice PAC ID | 0547314544 |
| Number of Group Practice Members | 2 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 050017 | MERCY GENERAL HOSPITAL |
| 050590 | METHODIST HOSPITAL OF SACRAMENTO |
| 050108 | SUTTER MEDICAL CENTER, SACRAMENTO |
| Address | Phone | Organization |
|---|---|---|
| 2382 Maritime Dr, Suite 100, Elk Grove, CA 95758-3659 | 9166916622 | CIRCLE OF LIFE MEDICINE, INC |
| 2382 Maritime Dr, Elk Grove, CA 95758-3659 | 9166916622 | CIRCLE OF LIFE MEDICINE, INC |
| Organization Legal Name | CIRCLE OF LIFE MEDICINE, INC |
| Physicians | 1 |
| Street Address |
2382 MARITIME DR SUITE 100 |
| City | ELK GROVE |
| State | CA |
| Zip | 95758-3659 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kristin G Leach | Family Medicine | Permanente Medical Group Inc | 9201 Big Horn Blvd, Elk Grove, CA 95758-1240 |
| Andrew R Bregman | Psychiatry | Permanente Medical Group Inc | 9201 Big Horn Blvd, Elk Grove, CA 95758-1240 |
| James A Raines Jr. | Psychologist, Clinical | Permanente Medical Group Inc | 9201 Big Horn Blvd, Elk Grove, CA 95758-1240 |
| Ahmed S Farrag | Internal Medicine | Permanente Medical Group Inc | 9201 Big Horn Blvd, Elk Grove, CA 95758-1240 |
| Lynne Chi Vong | Internal Medicine | Permanente Medical Group Inc | 9201 Big Horn Blvd, Elk Grove, CA 95758-1240 |
| Royal Y Gee | Nurse Practitioner | Permanente Medical Group Inc | 9201 Big Horn Blvd, Elk Grove, CA 95758-1240 |
| Latifa Pacheco | Family Medicine | Permanente Medical Group Inc | 9201 Big Horn Blvd, Elk Grove, CA 95758-1240 |
| Steven M Frisby | Optometry | Permanente Medical Group Inc | 9201 Big Horn Blvd, Elk Grove, CA 95758-1240 |
| Angie M Yu | Psychiatry | Permanente Medical Group Inc | 9201 Big Horn Blvd, Elk Grove, CA 95758-1240 |
| Jena B Torres | Family Medicine | Permanente Medical Group Inc | 9201 Big Horn Blvd, Elk Grove, CA 95758-1240 |
| Find all physicians in zip 95758 | |||
| City | ELK GROVE |
| Zip Code | 95758 |
| Specialty | INTERNAL MEDICINE |
| City + Specialty | ELK GROVE + INTERNAL MEDICINE |
Please comment or provide details below to improve the information on Jude Thaddeus Waterbury.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.