Organization
WATERTOWN PHYSICIAN PRACTICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNETTA TRAYLOR (AO)
(502) 596-6063
Entity
Organization
Contact information
Practice address
111 DODGE ST, WATERTOWN, WI 53094-4434
(920) 262-1460
Mailing address
680 S 4TH ST, LOUISVILLE, KY 40202-2407
(502) 596-6063
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
01/10/2020
Last updated
06/26/2025
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