Provider Demographics
NPI:1326136292
Name:WATSON, DURWARD ALLEN (PAC)
Entity Type:Individual
Prefix:MR
First Name:DURWARD
Middle Name:ALLEN
Last Name:WATSON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3900 JUNIUS ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1602
Mailing Address - Country:US
Mailing Address - Phone:214-521-5191
Mailing Address - Fax:
Practice Address - Street 1:2909 LEMMON AVENUE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204
Practice Address - Country:US
Practice Address - Phone:214-828-4702
Practice Address - Fax:214-828-1007
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00318363A00000X
TXG2108207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant