Provider Demographics
NPI:1912981499
Name:WATTS, JEFFREY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
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 1:3509 FRENCH PARK DR STE E
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-7291
Mailing Address - Country:US
Mailing Address - Phone:405-285-6901
Mailing Address - Fax:405-285-6902
Practice Address - Street 1:3509 FRENCH PARK DR STE E
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-7291
Practice Address - Country:US
Practice Address - Phone:405-285-6901
Practice Address - Fax:405-285-6902
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK215492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100091420BMedicaid
OK100091420AMedicaid
OKP00215936OtherRR MEDICARE
G45025Medicare UPIN
OK244517201Medicare PIN