Provider Demographics
NPI:1427306190
Name:WATTS, MICHAEL T (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:WATTS
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1490 E FOREMASTER DR
Mailing Address - Street 2:STE 320
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4488
Mailing Address - Country:US
Mailing Address - Phone:435-628-3334
Mailing Address - Fax:435-628-3375
Practice Address - Street 1:1490 E FOREMASTER DR
Practice Address - Street 2:STE 320
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4488
Practice Address - Country:US
Practice Address - Phone:435-628-3334
Practice Address - Fax:435-628-3375
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2016-01-29
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Provider Licenses
StateLicense IDTaxonomies
NVPA1369363AM0700X
UT8598508-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical