Individual
KENNETH LEROY WATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
310 2ND AVE SW STE 208, MIAMI, OK 74354-6702
(918) 540-7870
(918) 540-7832
Mailing address
3001 QUAIL SPRINGS PKWY FL 5, OKLAHOMA CITY, OK 73134-2640
(918) 540-7870
(918) 540-7832
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2013032884
MO
208600000X
Surgery Physician
Primary
25530
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200116470A
—
OK
Enumeration date
05/16/2007
Last updated
01/11/2025
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