Provider Demographics
NPI:1891981809
Name:ROY J WATTS DO PC
Entity Type:Organization
Organization Name:ROY J WATTS DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-546-0240
Mailing Address - Street 1:13613 W CAMINO DEL SOL
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4480
Mailing Address - Country:US
Mailing Address - Phone:623-546-0240
Mailing Address - Fax:623-546-9877
Practice Address - Street 1:13613 W CAMINO DEL SOL
Practice Address - Street 2:SUITE #1
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4480
Practice Address - Country:US
Practice Address - Phone:623-546-0240
Practice Address - Fax:623-546-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2156207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ161977Medicaid
AZZ63248Medicare PIN
AZ161977Medicaid