Provider Demographics
NPI:1063451763
Name:WATSON, BROOKS II (MD)
Entity Type:Individual
Prefix:
First Name:BROOKS
Middle Name:
Last Name:WATSON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 BELLERIVE DR
Mailing Address - Street 2:#198
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8807
Mailing Address - Country:US
Mailing Address - Phone:509-554-0317
Mailing Address - Fax:509-628-2951
Practice Address - Street 1:8220 W GAGE BLVD
Practice Address - Street 2:750
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8113
Practice Address - Country:US
Practice Address - Phone:509-554-0317
Practice Address - Fax:509-628-2951
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00042838208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1306897681OtherPROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
WA8376162Medicaid
WA000301271Medicare PIN
WAH42789Medicare UPIN
WA8376162Medicaid