Provider Demographics
NPI:1134177488
Name:WATTS, DAVID J (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:WATTS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:909 N 96TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2497
Mailing Address - Country:US
Mailing Address - Phone:402-330-4555
Mailing Address - Fax:402-934-0945
Practice Address - Street 1:909 N 96TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2497
Practice Address - Country:US
Practice Address - Phone:402-330-4555
Practice Address - Fax:402-934-0945
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE20113207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025555000Medicaid
NEE52382Medicare UPIN
NE281564Medicare PIN