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General NPI Number Information
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NPI Number | 1396062584
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Entity Type | Individual
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Provider Name | JASON ALEXANDER WATTS MD PHD
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Gender | Male
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Dates
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Enumeration Date | 04/27/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1500 EAST MEDICAL CENTER DRIVE 3RD FLOOR TAUBMAN CENTER RECP C
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City | ANN ARBOR
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State | MI
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Zip | 48109-5364
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Country | US
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Telephone | 734-936-5548
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Fax |
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Provider Business Mailing Address
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Address Line | 3621 SOUTH STATE STREET 700 KMS PLACE
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City | ANN ARBOR
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State | MI
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Zip | 48108
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Country | US
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Telephone | 734-936-2047
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2013-01064
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301105871
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 4301105871
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License Number State | MI
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