Provider Demographics
NPI:1093899098
Name:WATTERSON, PAUL ALMA (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ALMA
Last Name:WATTERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11762 S STATE ST STE 220
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7156
Mailing Address - Country:US
Mailing Address - Phone:801-571-2020
Mailing Address - Fax:801-571-6899
Practice Address - Street 1:11762 S STATE ST STE 220
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7156
Practice Address - Country:US
Practice Address - Phone:801-571-2020
Practice Address - Fax:801-571-6899
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10812842-1205208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE55728Medicare UPIN