Healthcare Provider Details

I. General information

NPI: 1770924862
Provider Name (Legal Business Name): JAMES A WATT JR. IONM TECH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 W WASHINGTON AVE STE 302
LAS VEGAS NV
89128-4340
US

IV. Provider business mailing address

7455 W WASHINGTON AVE STE 302
LAS VEGAS NV
89128-4340
US

V. Phone/Fax

Practice location:
  • Phone: 855-864-4322
  • Fax:
Mailing address:
  • Phone: 855-864-4322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: