Basic Information
| Provider Information | |||||||||
| NPI: | 1386630598 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5462 STATE ST | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486033678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894984061 | ||||||||
| FaxNumber: | 9894984064 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 S JEFFERSON AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486071267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897539000 | ||||||||
| FaxNumber: | 9897534024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 03/19/2008 | ||||||||
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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 | 363AM0700X | 5601003921 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.