MEDICARE: ROY JAY WATTS DO

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	2156	AZ

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	:	1770699308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROY JAY WATTS DO

Provider Business Mailing Address
First Line	:	13921 W GRAND AVE
Second Line	:	SUITE 502
City	:	SURPRISE
State	:	AZ
Zip	:	85374-2439
Country	:	US
Telephone Number	:	623-214-2200
Fax Number	:	623-214-2208

Provider Business Practice Location Address
First Line	:	13921 W GRAND AVE
Second Line	:	SUITE 502
City	:	SURPRISE
State	:	AZ
Zip	:	85374-2439
Country	:	US
Telephone Number	:	623-214-2200
Fax Number	:	623-214-2208

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	10/02/2015

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Directions to “ ROY JAY WATTS DO” Practice Location

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