Basic Information
| Provider Information | |||||||||
| NPI: | 1356329627 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2660 | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507042660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192333044 | ||||||||
| FaxNumber: | 3192330722 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 E GRANT ST | ||||||||
| Address2: | |||||||||
| City: | MACOMB | ||||||||
| State: | IL | ||||||||
| PostalCode: | 614553313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3098375368 | ||||||||
| FaxNumber: | 3192330722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 07/30/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | 36058185 | IL | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0101X | 20382 | IA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No ID Information.