Provider Demographics
NPI:1437512522
Name:WATTS-WOJCIK, PAULA JEAN (DO)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:WATTS-WOJCIK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1643 NW 136TH AVE BLDG H-100
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3091
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 WELLS ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2934
Practice Address - Country:US
Practice Address - Phone:401-348-3670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT76661207R00000X
CO1437512522207R00000X
CO0059349208M00000X
RIDO01311207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1437512522Medicaid
CT1437512522Medicaid