Provider Demographics
NPI:1588620918
Name:WATT, CHARLES G (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:G
Last Name:WATT
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:7529 CORAL RIVER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2619
Mailing Address - Country:US
Mailing Address - Phone:702-450-1717
Mailing Address - Fax:702-947-6740
Practice Address - Street 1:6970 W. PATRICK LANE
Practice Address - Street 2:SUITE #140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0270
Practice Address - Country:US
Practice Address - Phone:702-450-1717
Practice Address - Fax:702-947-6740
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2010-08-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9356207R00000X, 207Q00000X
NVDO 1375207R00000X, 207Q00000X
NV1375207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBU351Medicare PIN