Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ty Waters

Individual provider Family Medicine Physician · NPI 1518492388

Ty Waters is a Family Practice in Boise, Idaho. Graduated from University of Nevada School of Medicine in 2017, 9 years ago. Practices with St Lukes Clinic-Treasure Valley LLC, a 1,150-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
9
Trained at
University of Nevada School of Medicine
Licensed in
ID
In the registry since
2017
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Practice location Address checks out

777 N Raymond St
Boise, ID 83704-9251
Phone: (208) 514-2500
Fax: (208) 375-2217
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence MRM-1630 (ID)

Record details

NPI number1518492388
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 28, 2017
Last updated in NPPESApril 28, 2017
Mailing address777 N Raymond St, Boise, ID 83704-9251

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolUNIVERSITY OF NEVADA SCHOOL OF MEDICINE
Graduated 2017 (9 years in practice)
Group practice St Lukes Clinic-Treasure Valley Llc — 1150 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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