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General NPI Number Information
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NPI Number | 1427231729
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Entity Type | Individual
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Provider Name | JESSICA LEA WATTERS M.D., MPH
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Gender | Female
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 108 ARIZONA ST
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City | BISBEE
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State | AZ
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Zip | 85603-1804
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Country | US
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Telephone | 520-432-3309
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Fax | 520-364-4261
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Provider Business Mailing Address
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Address Line | PO BOX 8336
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City | TUCSON
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State | AZ
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Zip | 85738-0336
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Country | US
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Telephone | 520-975-3676
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Fax | 520-372-0017
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A108160
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 61025
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License Number State | AZ
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