Cantrell Eugene Watts

Key facts

NPI

1750899100

Entity type

Individual (NPI type 1)

Primary specialty

Peer Specialist 175T00000X

Practice address

6016 SE 5TH St
Midwest City, OK 73110-2250

Phone

(405) 886-8659

NPI assigned

Jan 19, 2018

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 19, 2018.

{
    "created_epoch": "1516320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516320000000",
    "number": "1750899100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6016 SE 5TH ST",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731102250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6016 SE 5TH ST",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731102250",
            "telephone_number": "405-886-8659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATTS",
        "first_name": "CANTRELL",
        "middle_name": "EUGENE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-19",
        "last_updated": "2018-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Midwest City, OK · Peer Specialist in Oklahoma