Provider Demographics
NPI:1518904937
Name:WATTY, HUBERT H (MD)
Entity Type:Individual
Prefix:DR
First Name:HUBERT
Middle Name:H
Last Name:WATTY
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:P. O. BOX 9281, #2
Mailing Address - Street 2:
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00850-9741
Mailing Address - Country:US
Mailing Address - Phone:340-778-1932
Mailing Address - Fax:340-778-1935
Practice Address - Street 1:PLOT 6 CLIFTON HILL
Practice Address - Street 2:
Practice Address - City:KINGSHILL
Practice Address - State:VI
Practice Address - Zip Code:00850
Practice Address - Country:US
Practice Address - Phone:340-778-1932
Practice Address - Fax:340-778-1935
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK23898OtherLICENSE (MEDICAL)
OK200046880BMedicaid
OK721603516OtherTIN