Individual
DAVID O WATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CST SFA
Contact information
Practice address
1023 NEW MOODY LN, SUITE 102, LA GRANGE, KY 40031-9177
(502) 222-0598
(502) 222-7446
Mailing address
PO BOX 950248, LOUISVILLE, KY 40295-0248
(502) 489-5730
(502) 489-5753
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
SA067
KY
246ZS0410X
Surgical Technologist
90544
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000210309
ANTHEM
KY
Enumeration date
12/08/2006
Last updated
03/03/2016
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