1598840191 NPI number — GARY B WATTS M.D.

Table of content: GARY B WATTS M.D. (NPI 1598840191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598840191 NPI number — GARY B WATTS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATTS
Provider First Name:
GARY
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WATTS
Provider Other First Name:
GARY
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D., P.A.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1598840191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2925 COUNTRY CLUB RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76210-8603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-382-1120
Provider Business Mailing Address Fax Number:
940-383-1499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2925 COUNTRY CLUB RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76210-8603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-382-1120
Provider Business Practice Location Address Fax Number:
940-383-1499
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  H6692 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0612725 . This is a "AETNA HMO PROV NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 136782306 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 260016774 . This is a "RAILROAD MEDICARE PROV #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0004266484 . This is a "AETNA PPO PROV NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 127555 . This is a "VALUE OPTION PROV #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 752435278 . This is a "TRICARE PROV NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 128256 . This is a "MHN PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: E81496 . This is a "STERLING OPTION PROV #" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com