Provider Demographics
NPI:1518269133
Name:GARY B. WATTS, M.D, P.A.
Entity Type:Organization
Organization Name:GARY B. WATTS, M.D, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-382-1120
Mailing Address - Street 1:2925 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-8603
Mailing Address - Country:US
Mailing Address - Phone:940-382-1120
Mailing Address - Fax:940-383-1499
Practice Address - Street 1:2925 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8603
Practice Address - Country:US
Practice Address - Phone:940-382-1120
Practice Address - Fax:940-383-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH66922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
128256OtherMHN PROVIDER #
0612725OtherAETNA HMO PROV #
127555OtherVALUE OPTIONS PROV #
TX260016774OtherRAILROAD MEDICARE PROIDER #
TX136782306Medicaid
0004266484OtherAETNA PPO PROVIDER #
E81496OtherSTERLING OPTIONS PROV #
TX00K78CMedicare UPIN