Provider Demographics
NPI:1316972656
Name:WATTERS, HARRY C (DO)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:C
Last Name:WATTERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 E ENCINAS AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-3462
Mailing Address - Country:US
Mailing Address - Phone:480-732-7401
Mailing Address - Fax:480-732-9478
Practice Address - Street 1:604 W WARNER RD
Practice Address - Street 2:SUITE #C-3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2906
Practice Address - Country:US
Practice Address - Phone:480-732-7401
Practice Address - Fax:480-732-9478
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1927207V00000X
AZAZ01927207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ231051Medicaid
AZ70154Medicare ID - Type Unspecified
AZ231051Medicaid