Provider Demographics
NPI:1376515783
Name:WATSON, RICHARD O (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:O
Last Name:WATSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:704 BUCHANAN
Mailing Address - Street 2:HWY 50 W, CAPITAL REGION MEDICAL CLINIC CALIFORNIA
Mailing Address - City:CALIFORNIA
Mailing Address - State:MO
Mailing Address - Zip Code:65018
Mailing Address - Country:US
Mailing Address - Phone:573-796-3111
Mailing Address - Fax:573-796-3042
Practice Address - Street 1:704 BUCHANAN
Practice Address - Street 2:HWY 50 W
Practice Address - City:CALIFORNIA
Practice Address - State:MO
Practice Address - Zip Code:65018
Practice Address - Country:US
Practice Address - Phone:573-796-3111
Practice Address - Fax:573-796-3042
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO28014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
119191OtherHEALTHLINK
MO240869909Medicaid
813095OtherFIRST HEALTH
440546366OtherUNITED HEALTH CARE
4196962OtherCIGNA
P00091254OtherRR MEDICARE
25415OtherBLUE CROSS BLUE SHIELD
D41665OtherMERCY
D41665Medicare UPIN
MO909992296Medicare ID - Type Unspecified