Provider Demographics
NPI:1225146384
Name:WATSON, LAVON MONROE I (LMP)
Entity Type:Individual
Prefix:MR
First Name:LAVON
Middle Name:MONROE
Last Name:WATSON
Suffix:I
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 165TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3907
Mailing Address - Country:US
Mailing Address - Phone:425-861-7334
Mailing Address - Fax:425-895-0297
Practice Address - Street 1:8310 165TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3907
Practice Address - Country:US
Practice Address - Phone:425-861-7334
Practice Address - Fax:425-895-0297
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010917174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist