Provider Demographics
NPI:1679737084
Name:WATTS, JENNIFER (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 SPRUCE ST # T
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6921
Mailing Address - Country:US
Mailing Address - Phone:303-324-2053
Mailing Address - Fax:
Practice Address - Street 1:98 SPRUCE ST # T
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6921
Practice Address - Country:US
Practice Address - Phone:303-324-2053
Practice Address - Fax:303-403-6315
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR-46317207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR0046317OtherSTATE LICENSE
CO12471585Medicaid