Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | L5180 | TX |
NPI | 1285600684 |
---|---|
Provider Name | Dr. Paul Wallace Watts |
First Address | Abilene, TX 79601-3043 |
Second Address | Abilene, TX 79601-3043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 10/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200365110A | (05) | KS |
8K6896 | MEDICARE (01) | TX |
H71842 | (02) | TX |