Provider Demographics
NPI:1932148616
Name:WATTS, RICHARD DAMON (PA)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DAMON
Last Name:WATTS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:655 N ALVERNON
Mailing Address - Street 2:SUITE 216 ARIZONA COMMUNITY PHYSICIANS PC
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:6565 E CARONDELET
Practice Address - Street 2:SUITE 285 CLARA VISTA MEDICAL ASSOCIATES
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710
Practice Address - Country:US
Practice Address - Phone:520-547-7045
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ1884363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S58695Medicare UPIN