Provider Demographics
NPI:1922052075
Name:WATT, BRUCE A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:A
Last Name:WATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5009
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5009
Mailing Address - Country:US
Mailing Address - Phone:605-977-5000
Mailing Address - Fax:605-977-5377
Practice Address - Street 1:4520 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8148
Practice Address - Country:US
Practice Address - Phone:605-977-5000
Practice Address - Fax:605-977-5377
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1655207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6000872Medicaid
MN4T612WAOtherMN BCBS - PLAN 91057NO
MN415088100Medicaid
IA0933036Medicaid
SD1655OtherDAKOTACARE
24694OtherHEALTH PARTNERS
165035OtherUCARE
931451029050OtherPREFERRED ONE
SD0003371OtherSD BCBS
25-00495OtherMEDICA SELECTCARE
IA53997OtherIA BCBS
MN539ROWAOtherMN BCBS - PLAN 538R2NO
SDS3371Medicare PIN
25-00495OtherMEDICA SELECTCARE
SD1655OtherDAKOTACARE
931451029050OtherPREFERRED ONE
IAI0602Medicare PIN