Provider Demographics
NPI:1215914361
Name:WATTS, JEFFERSON DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:DOUGLAS
Last Name:WATTS
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 1:6336 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-7812
Mailing Address - Country:US
Mailing Address - Phone:407-447-4283
Mailing Address - Fax:407-447-4274
Practice Address - Street 1:8485 SE 165TH MULBERRY LN
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5847
Practice Address - Country:US
Practice Address - Phone:352-753-1727
Practice Address - Fax:352-753-7567
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 93130170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04016ZMedicare ID - Type Unspecified
FLE42649Medicare UPIN