Provider Demographics
NPI:1114366416
Name:JON THOMAS WATSON MD PA
Entity Type:Organization
Organization Name:JON THOMAS WATSON MD PA
Other - Org Name:SOUTH TEXAS MOBILE IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-774-4831
Mailing Address - Street 1:14838 COBO DE BARA CIR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-6908
Mailing Address - Country:US
Mailing Address - Phone:361-949-0994
Mailing Address - Fax:361-228-2136
Practice Address - Street 1:14838 COBO DE BARA CIR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6908
Practice Address - Country:US
Practice Address - Phone:361-949-0994
Practice Address - Fax:361-228-2136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL12342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1154427813OtherNPI
TX1154427813OtherNPI