Healthcare Provider Details

I. General information

NPI: 1518904937
Provider Name (Legal Business Name): HUBERT H. WATTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLOT 6 CLIFTON HILL
KINGSHILL VI
00850
US

IV. Provider business mailing address

P. O. BOX 9281, #2
KINGSHILL VI
00850-9741
US

V. Phone/Fax

Practice location:
  • Phone: 340-778-1932
  • Fax: 340-778-1935
Mailing address:
  • Phone: 340-778-1932
  • Fax: 340-778-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23898
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: