Basic Information
| Provider Information | |||||||||
| NPI: | 1265735062 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KEITH A WATSON MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 KAHOE LN | ||||||||
| Address2: | |||||||||
| City: | YELLOW SPRINGS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453871243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377677311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 KAHOE LN | ||||||||
| Address2: | |||||||||
| City: | YELLOW SPRINGS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453871243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377677311 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2010 | ||||||||
| LastUpdateDate: | 01/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | WATSON | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9377677311 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 35043758 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0496780 | 05 | OH | MEDICAID |