Healthcare Provider Details

I. General information

NPI: 1467701862
Provider Name (Legal Business Name): JAMES F. WATT DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 MAR WALT DR SUITE 100
FORT WALTON BEACH FL
32547-6639
US

IV. Provider business mailing address

1034 MAR WALT DR SUITE 100
FORT WALTON BEACH FL
32547-6639
US

V. Phone/Fax

Practice location:
  • Phone: 850-863-2153
  • Fax: 850-863-8085
Mailing address:
  • Phone: 850-863-2153
  • Fax: 850-863-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANNON M FUNK
Title or Position: BUSINESS OFFICE LIASON
Credential:
Phone: 850-315-9212