Basic Information
| Provider Information | |||||||||
| NPI: | 1376687822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13837 CIRCA CROSSING DRIVE | ||||||||
| Address2: | |||||||||
| City: | LITHIA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136842663 | ||||||||
| FaxNumber: | 8136586222 | ||||||||
| Practice Location | |||||||||
| Address1: | 4541 S DALE MABRY HWY | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336111407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136842663 | ||||||||
| FaxNumber: | 8138773017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2007 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | ME112198 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.