Individual
KYLE ERNEST WATFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10630 CLEMSON BLVD STE 100, SENECA, SC 29678-4545
(864) 482-6000
Mailing address
1 INDEPENDENCE POINTE, SUITE 212, GREENVILLE, SC 29615-4536
(864) 797-6328
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
20275
SC
207XX0801X
Orthopaedic Trauma Physician
Primary
20275
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055
BCBS
SC
01
—
20072627
SELECT HEALTH
SC
05
—
202756
—
SC
01
—
206186
MEDCOST
SC
01
—
5909037
NC MEDICAID
NC
01
—
7574373
AETNA
SC
01
—
8000830
CIGNA
SC
01
—
H640278552
MEDICARE PTAN
SC
Enumeration date
02/02/2006
Last updated
08/31/2017
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