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General NPI Number Information
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NPI Number | 1871652586
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Entity Type | Individual
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Provider Name | DAVID O WATTS CST SFA
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Gender | Male
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 1023 NEW MOODY LN SUITE 102
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City | LA GRANGE
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State | KY
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Zip | 40031-9177
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Country | US
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Telephone | 502-222-0598
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Fax | 502-222-7446
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Provider Business Mailing Address
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Address Line | PO BOX 950248
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City | LOUISVILLE
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State | KY
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Zip | 40295-0248
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Country | US
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Telephone | 502-489-5730
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Fax | 502-489-5753
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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 | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 90544
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | SA067
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License Number State | KY
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