Healthcare Provider Details

I. General information

NPI: 1316972656
Provider Name (Legal Business Name): HARRY C WATTERS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 W WARNER RD SUITE #C-3
CHANDLER AZ
85225-2906
US

IV. Provider business mailing address

621 E ENCINAS AVE
GILBERT AZ
85234-3462
US

V. Phone/Fax

Practice location:
  • Phone: 480-732-7401
  • Fax: 480-732-9478
Mailing address:
  • Phone: 480-732-7401
  • Fax: 480-732-9478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1927
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberAZ01927
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: