Provider Demographics
NPI:1285600684
Name:WATTS, PAUL WALLACE (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WALLACE
Last Name:WATTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1749 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-3043
Mailing Address - Country:US
Mailing Address - Phone:325-672-4372
Mailing Address - Fax:325-673-0856
Practice Address - Street 1:1749 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-3043
Practice Address - Country:US
Practice Address - Phone:325-672-4372
Practice Address - Fax:325-673-0856
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5180207QS0010X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200365110AMedicaid
TX8K6896OtherMEDICARE
KS105274Medicare ID - Type Unspecified
TX8K6896OtherMEDICARE