=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598840191
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARY B WATTS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 12/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2925 COUNTRY CLUB RD SUITE 102
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76210-8603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-382-1120
-----------------------------------------------------
Fax | 940-383-1499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2925 COUNTRY CLUB RD SUITE 102
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76210-8603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-382-1120
-----------------------------------------------------
Fax | 940-383-1499
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | H6692
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------