Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 20113 | NE |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 20113 | NE |
NPI | 1134177488 |
---|---|
Provider Name | David J Watts |
First Address | Omaha, NE 68114-2497 |
Second Address | Omaha, NE 68114-2497 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 11/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025555000 | (05) | NE |
E52382 | (02) | NE |