MEDICARE: DOUGLAS ELRY WATFORD MD

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	207Q00000X	Family Medicine Physician	35546	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104884998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS ELRY WATFORD MD

Provider Business Mailing Address
First Line	:	PO BOX 5281
Second Line	:
City	:	KINSTON
State	:	NC
Zip	:	28503
Country	:	US
Telephone Number	:	252-527-8906
Fax Number	:	252-527-9816

Provider Business Practice Location Address
First Line	:	400 GLENWOOD AVE
Second Line	:	STE 3
City	:	KINSTON
State	:	NC
Zip	:	28501
Country	:	US
Telephone Number	:	252-527-8906
Fax Number	:	252-527-9816

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	02/08/2026

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