Provider Demographics
NPI:1225031131
Name:WATSON, GORDON KIRK (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:KIRK
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 1:3709 N CAMPBELL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1563
Mailing Address - Country:US
Mailing Address - Phone:520-838-2122
Mailing Address - Fax:520-838-2245
Practice Address - Street 1:1238 W ORANGE GROVE RD STE 103
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-2950
Practice Address - Country:US
Practice Address - Phone:520-838-3540
Practice Address - Fax:520-325-3526
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24145207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ005502492OtherCIGNA
IA0562942Medicaid
AZ5725261OtherAETNA
AZAZ0860260OtherBCBS OF ARIZONA
AZ10055691OtherPPO NEXT
AZ060057125OtherRAILROAD MEDICARE
AZ2198510OtherGHI
AZ25-00273OtherUNITED HEALTHCARE
CAXPY197517Medicaid
AZ1Z3643OtherHEALTH NET
AZ933773OtherFIRST HEALTH
AZ346355Medicaid
AZ5073471OtherCCN
AZZ29523Medicare PIN
AZ5725261OtherAETNA
AZ346355Medicaid
CAXPY197517Medicaid
139800Medicare PIN
AZZ61535Medicare PIN