MEDICARE: KARL N WATTS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	M5548	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578591053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARL N WATTS MD

Provider Business Mailing Address
First Line	:	3340 E GOLDSTONE WAY
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642
Country	:	US
Telephone Number	:	208-302-5600
Fax Number	:	208-302-5655

Provider Business Practice Location Address
First Line	:	10255 OVERLAND RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-1430
Country	:	US
Telephone Number	:	208-302-5600
Fax Number	:	208-302-5655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	11/15/2016

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Directions to “ KARL N WATTS MD” Practice Location

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