1467701862 NPI number — JAMES F. WATT DO PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467701862 NPI number — JAMES F. WATT DO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES F. WATT DO PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467701862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1034 MAR WALT DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FORT WALTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32547-6639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-863-2153
Provider Business Mailing Address Fax Number:
850-863-8085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1034 MAR WALT DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FORT WALTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32547-6639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-863-2153
Provider Business Practice Location Address Fax Number:
850-863-8085
Provider Enumeration Date:
08/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FUNK
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BUSINESS OFFICE LIASON
Authorized Official Telephone Number:
850-315-9212

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14E4H . This is a "BCBS PROVIDER MUMBER" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com