Provider Demographics
NPI:1043309776
Name:WATSON, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:WATSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5301 N DIXIE HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3403
Mailing Address - Country:US
Mailing Address - Phone:954-771-9920
Mailing Address - Fax:954-771-9922
Practice Address - Street 1:5301 N DIXIE HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3403
Practice Address - Country:US
Practice Address - Phone:954-771-9920
Practice Address - Fax:954-771-9922
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-02-13
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Provider Licenses
StateLicense IDTaxonomies
FLME0046623207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049418600Medicaid
D65841Medicare UPIN
FL049418600Medicaid