Provider Demographics
NPI:1720486509
Name:WATTS, ELIHU (OPA-C, CSFA)
Entity Type:Individual
Prefix:
First Name:ELIHU
Middle Name:
Last Name:WATTS
Suffix:
Gender:M
Credentials:OPA-C, CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29370-3816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 SPURS LN STE 245
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1689
Practice Address - Country:US
Practice Address - Phone:210-487-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant