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Individual
DR. PAUL WALLACE WATTS
Active
Individual
DR. PAUL WALLACE WATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
L5180
TX
208VP0014X
Interventional Pain Medicine Physician
L5180
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200365110A
—
KS
01
—
8K6896
MEDICARE
TX
Enumeration date
02/24/2006
Last updated
08/10/2011
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