Basic Information
| Provider Information | |||||||||
| NPI: | 1942235676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATSON | ||||||||
| FirstName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37491 ENTERPRISE DR | ||||||||
| Address2: | |||||||||
| City: | BURNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960134386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303355457 | ||||||||
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| Practice Location | |||||||||
| Address1: | 37491 ENTERPRISE DR | ||||||||
| Address2: | |||||||||
| City: | BURNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960134386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303355457 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 01/05/2013 | ||||||||
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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 | 207P00000X | G54134 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | G54134 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.