Active NPI
Paul Alma Watterson, MD
- Plastic Surgery Physician
- Draper, UT
National Provider Identifier
1093899098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 10812842-1205
- Practice address
- 11762 S State St Ste 220
Draper, UT 84020-7156 - Phone
- (801) 571-2020
- Fax
- (801) 571-6899
- NPI assigned
- Oct 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 10812842-1205 | UT | Primary |
Addresses
Primary practice location
11762 S State St Ste 220
Draper, UT 84020-7156
Mailing address
11762 S State St Ste 220
Draper, UT 84020-7156
Phone (801) 571-2020
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 1, 2013 through Mar 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10812842-1205 | UT | MD | Plastic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728000000000",
"number": "1093899098",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11762 S STATE ST STE 220",
"city": "DRAPER",
"state": "UT",
"postal_code": "840207156",
"telephone_number": "801-571-2020",
"fax_number": "801-571-6899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11762 S STATE ST STE 220",
"city": "DRAPER",
"state": "UT",
"postal_code": "840207156",
"telephone_number": "801-571-2020",
"fax_number": "801-571-6899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATTERSON",
"first_name": "PAUL",
"middle_name": "ALMA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-25",
"last_updated": "2024-10-04",
"certification_date": "2024-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "UT",
"license": "10812842-1205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Draper, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.