Provider Demographics
NPI:1366462228
Name:WATT, JAMES ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:WATT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 S APOPKA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4845
Mailing Address - Country:US
Mailing Address - Phone:352-341-3344
Mailing Address - Fax:352-341-7700
Practice Address - Street 1:216 S APOPKA AVE STE A
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452
Practice Address - Country:US
Practice Address - Phone:352-341-3344
Practice Address - Fax:352-341-7700
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0006067207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3740013-00Medicaid
FLE90180Medicare UPIN
FL3740013-00Medicaid
FL80495Medicare ID - Type UnspecifiedPROVIDER NUMBER
FL40818Medicare ID - Type Unspecified2ND OFFICE LOCATION GROUP