Healthcare Provider Details

I. General information

NPI: 1023121035
Provider Name (Legal Business Name): RAYMOND G. WATTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HENRY CLAY AVE. 1ST FL
NEW ORLEANS LA
70118
US

IV. Provider business mailing address

200 HENRY CLAY AVE. 1ST FLOOR
NEW ORLEANS LA
70118
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-2723
  • Fax: 504-896-2720
Mailing address:
  • Phone: 504-896-2723
  • Fax: 504-896-9410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number300026
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: