Provider Demographics
NPI:1700210861
Name:HARRY C. WATTERS DO MPH-PC
Entity Type:Organization
Organization Name:HARRY C. WATTERS DO MPH-PC
Other - Org Name:ADVANCED MENS PERFORMANCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:WATTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO MPH-PC
Authorized Official - Phone:480-963-7900
Mailing Address - Street 1:604 W WARNER RD
Mailing Address - Street 2:E201
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2906
Mailing Address - Country:US
Mailing Address - Phone:480-963-7900
Mailing Address - Fax:480-732-9478
Practice Address - Street 1:604 W WARNER RD
Practice Address - Street 2:E201
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2906
Practice Address - Country:US
Practice Address - Phone:480-963-7900
Practice Address - Fax:480-732-9478
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARRY C. WATTERS DO MPH-PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1927174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty