Individual
DR. SAMUEL M. WATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1319 S LANDRUM ST, SUITE A, MOUNT VERNON, MO 65712-1910
(417) 466-2001
(417) 466-2005
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R5A74
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201690013
—
MO
Enumeration date
10/11/2006
Last updated
07/15/2008
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