Provider Demographics
NPI:1104865781
Name:WATSON, THOMAS LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LEE
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 1:303 S JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4924
Mailing Address - Country:US
Mailing Address - Phone:760-480-9051
Mailing Address - Fax:760-480-9054
Practice Address - Street 1:303 S JUNIPER ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4924
Practice Address - Country:US
Practice Address - Phone:760-480-9051
Practice Address - Fax:760-480-9054
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52193208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00521930Medicaid
CAF68610Medicare UPIN
CA00521930Medicaid