Provider Demographics
NPI:1023199346
Name:WATTS, LARRY KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:KEVIN
Last Name:WATTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 HILLTOP RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-3532
Mailing Address - Country:US
Mailing Address - Phone:913-441-4544
Mailing Address - Fax:913-442-8462
Practice Address - Street 1:6850 HILLTOP RD
Practice Address - Street 2:SUITE 190
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-3532
Practice Address - Country:US
Practice Address - Phone:913-441-4544
Practice Address - Fax:913-442-8462
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS 04-24213207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202509840Medicaid
KS100298130 KMedicaid
KS100298130 JMedicaid
KS100298130IMedicaid
KS100298130 KMedicaid
KS100298130IMedicaid
KSC51452Medicare UPIN
KS106708Medicare PIN