Basic Information
| Provider Information | |||||||||
| NPI: | 1205894797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | PEGGY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15320 AMBERLY DR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336471647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139770733 | ||||||||
| FaxNumber: | 8139712230 | ||||||||
| Practice Location | |||||||||
| Address1: | 20615 AMBERFIELD DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | LAND O LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346384301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139492950 | ||||||||
| FaxNumber: | 8139492924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 08/28/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME0081039 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.