MEDICARE: CHARLES G WATT D O P L L C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	DO1375	NV

General Provider Information

NPI Number	:	1063730364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES G WATT D O P L L C

Provider Business Mailing Address
First Line	:	PO BOX 36830
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-6830
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7529 CORAL RIVER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-2619
Country	:	US
Telephone Number	:	702-656-4150
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	CHARLES G WATT
Credential	:	DO
Telephone Number	:	702-656-4150

Provider Enumeration Date	:	05/11/2010
Last Update Date	:	07/19/2010

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