Provider Demographics
NPI:1902069313
Name:WATTS, CRAIG MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:MARTIN
Last Name:WATTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6991 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:HARTSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65039-9775
Mailing Address - Country:US
Mailing Address - Phone:573-893-4648
Mailing Address - Fax:
Practice Address - Street 1:6991 S SHORE DR
Practice Address - Street 2:
Practice Address - City:HARTSBURG
Practice Address - State:MO
Practice Address - Zip Code:65039-9775
Practice Address - Country:US
Practice Address - Phone:573-893-4648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8E122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOWA212430Medicaid
MOWA212430Medicaid
MO202441515Medicare Oscar/Certification