Provider Demographics
NPI:1023121035
Name:WATTS, RAYMOND G (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:G
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 1:200 HENRY CLAY AVE.
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118
Mailing Address - Country:US
Mailing Address - Phone:504-896-2723
Mailing Address - Fax:504-896-9410
Practice Address - Street 1:200 HENRY CLAY AVE.
Practice Address - Street 2:1ST FL
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118
Practice Address - Country:US
Practice Address - Phone:504-896-2723
Practice Address - Fax:504-896-2720
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3000262080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2404857Medicaid
AL000028883Medicaid
AL000018757Medicaid
AL000018757Medicaid