Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 35048999 | OH |
NPI | 1730180209 |
---|---|
Provider Name | Gregory A Watts |
First Address | Cleveland, OH 44124-4062 |
Second Address | Cleveland, OH 44124-4062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 11/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A16624 | (02) | OH |