Healthcare Provider Details

I. General information

NPI: 1295090355
Provider Name (Legal Business Name): DAVID CARLING WATTS D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CIVIC CENTER LN
LAKE HAVASU CITY AZ
86403-5607
US

IV. Provider business mailing address

1889 S 140TH PL
GILBERT AZ
85295-4740
US

V. Phone/Fax

Practice location:
  • Phone: 928-453-0150
  • Fax:
Mailing address:
  • Phone: 602-509-1930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number006550
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number006550
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: