Provider Demographics
NPI:1144431859
Name:KENNETH L WATTS MD PC
Entity type:Organization
Organization Name:KENNETH L WATTS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-233-9700
Mailing Address - Street 1:330 S 5TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5825
Mailing Address - Country:US
Mailing Address - Phone:580-233-9700
Mailing Address - Fax:580-234-9625
Practice Address - Street 1:330 S 5TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5825
Practice Address - Country:US
Practice Address - Phone:580-233-9700
Practice Address - Fax:580-234-9363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty