Provider Demographics
NPI:1396858247
Name:ARNOLD, WATSON C (MD)
Entity Type:Individual
Prefix:
First Name:WATSON
Middle Name:C
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 4TH STREET
Mailing Address - Street 2:STOP 9903
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-9903
Mailing Address - Country:US
Mailing Address - Phone:806-743-7336
Mailing Address - Fax:806-743-7329
Practice Address - Street 1:3601 4TH STREET
Practice Address - Street 2:STOP 9406
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-9406
Practice Address - Country:US
Practice Address - Phone:806-743-7336
Practice Address - Fax:806-743-7329
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD69302080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10028697OtherAMERIGROUP PIN
TX137831707OtherCSHCN IND TPI NUMBER
TX1416412OtherFIRSTHEALTH PIN
TX4243069OtherAETNA PIN
TX822100OtherUHC PIN
TX124027OtherSUPERIOR PIN
TX137831709Medicaid
TX138412511Medicaid
TX140442854Medicaid
TX00U87ZOtherBCBSTX GRP PIN
TX107700100OtherFIRSTCARE PIN
TX4605937OtherCIGNA PIN
TX87Y110OtherBCBSTX IND PIN
TX378120OtherPHCS PIN
TX822100OtherUHC PIN
TX00147TMedicare ID - Type UnspecifiedGRP MEDICARE
TX140442854Medicaid