Provider Demographics
NPI:1366460347
Name:WATSON, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2345 E PRATER WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9634
Mailing Address - Country:US
Mailing Address - Phone:775-851-1505
Mailing Address - Fax:775-851-1583
Practice Address - Street 1:5575 KIETZKE LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2290
Practice Address - Country:US
Practice Address - Phone:775-851-1505
Practice Address - Fax:775-851-1583
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV11947207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11614959OtherCAQH
NV1366460347Medicaid
NV1366460347Medicaid
NVV102830Medicare PIN