Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 134974 | NC |
Y | 2080P0203X | Pediatric Critical Care Doctor | 11371979-1205 | UT |
NPI | 1184899460 |
---|---|
Provider Name | Dr. Kevin Michael Watt |
First Address | Durham, NC 27710 |
Second Address | Durham, NC 27710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2008 |
Last Update Date | 23/11/2021 |