Provider Demographics
NPI:1316204464
Name:WATSON, ASHLEY (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:GULLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3806
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3806
Mailing Address - Country:US
Mailing Address - Phone:206-622-7747
Mailing Address - Fax:
Practice Address - Street 1:1001 SW KLICKITAT WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1161
Practice Address - Country:US
Practice Address - Phone:206-622-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60269201207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology