Provider Demographics
NPI:1376610832
Name:WATSON, DENNIS ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ROBERT
Last Name:WATSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6661 S CALLAWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4447
Mailing Address - Country:US
Mailing Address - Phone:480-540-4737
Mailing Address - Fax:
Practice Address - Street 1:6661 S CALLAWAY DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-4447
Practice Address - Country:US
Practice Address - Phone:480-540-4737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2645207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE25776Medicare UPIN