Healthcare Provider Details

I. General information

NPI: 1427231729
Provider Name (Legal Business Name): JESSICA LEA WATTERS M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ARIZONA ST
BISBEE AZ
85603-1804
US

IV. Provider business mailing address

PO BOX 8336
TUCSON AZ
85738-0336
US

V. Phone/Fax

Practice location:
  • Phone: 520-432-3309
  • Fax: 520-364-4261
Mailing address:
  • Phone: 520-975-3676
  • Fax: 520-372-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA108160
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number61025
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: