Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 17528 | OK |
NPI | 1255373122 |
---|---|
Provider Name | Dr. Garrett Edward Watts |
First Address | Tulsa, OK 74133-5598 |
Second Address | Tulsa, OK 74133-5598 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 09/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100135870A | (05) | OK |
731402121001 | BLUE CROSS BLUE SHIELD (01) | OK |
C36355 | (02) | OK |