Provider Demographics
NPI:1598840191
Name:WATTS, GARY B (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:B
Last Name:WATTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:B
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PA
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
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH66922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0612725OtherAETNA HMO PROV NUMBER
TX136782306Medicaid
TX260016774OtherRAILROAD MEDICARE PROV #
0004266484OtherAETNA PPO PROV NUMBER
127555OtherVALUE OPTION PROV #
752435278OtherTRICARE PROV NUMBER
128256OtherMHN PROVIDER NUMBER
E81496OtherSTERLING OPTION PROV #
TX260016774OtherRAILROAD MEDICARE PROV #