Provider Demographics
NPI:1023007507
Name:WATSON, WILLIAM J (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 PEACH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2700
Mailing Address - Country:US
Mailing Address - Phone:805-545-5665
Mailing Address - Fax:805-544-6477
Practice Address - Street 1:1035 PEACH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2700
Practice Address - Country:US
Practice Address - Phone:805-545-5665
Practice Address - Fax:805-544-6477
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42368207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4036521OtherAETNA PIN
CAGR0046750CMedicaid
CAZZZ25994ZOtherBLUE SHIELD PIN
CAGR0046750CMedicaid
CA4036521OtherAETNA PIN