Provider Demographics
NPI:1770699308
Name:WATTS, ROY JAY (DO)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:JAY
Last Name:WATTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13921 W GRAND AVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2439
Mailing Address - Country:US
Mailing Address - Phone:623-214-2200
Mailing Address - Fax:623-214-2208
Practice Address - Street 1:13921 W GRAND AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2439
Practice Address - Country:US
Practice Address - Phone:623-214-2200
Practice Address - Fax:623-214-2208
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ161977Medicaid
AZZ63249Medicare ID - Type Unspecified
AZ161977Medicaid