Healthcare Provider Details

I. General information

NPI: 1700210861
Provider Name (Legal Business Name): HARRY C. WATTERS DO MPH-PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 W WARNER RD E201
CHANDLER AZ
85225-2906
US

IV. Provider business mailing address

604 W WARNER RD E201
CHANDLER AZ
85225-2906
US

V. Phone/Fax

Practice location:
  • Phone: 480-963-7900
  • Fax: 480-732-9478
Mailing address:
  • Phone: 480-963-7900
  • Fax: 480-732-9478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1927
License Number StateAZ

VIII. Authorized Official

Name: DR. HARRY C WATTERS
Title or Position: OWNER / CEO
Credential: DO MPH-PC
Phone: 480-963-7900