Provider Demographics
NPI:1679500698
Name:WATTS, WILLIAM R (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:WATTS
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5227
Mailing Address - Fax:740-441-8058
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5238
Practice Address - Fax:740-441-8058
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18395207L00000X
OH35-06-8356207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000193911OtherUNISON MEDICAID #
000000006613OtherANTHEM BCBS
OH0158565OtherMOLINA MEDICAID #
WV0061182000Medicaid
OH050040164OtherRR MEDICARE
001369668OtherMOUNTAIN STATE BCBS
OH0158565Medicaid
001369668OtherMOUNTAIN STATE BCBS
OH0158565Medicaid