Provider Demographics
NPI:1437104155
Name:WATSON, STEVEN J (DPM)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:J
Last Name:WATSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SMART PLACE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458
Mailing Address - Country:US
Mailing Address - Phone:985-649-0002
Mailing Address - Fax:985-649-0034
Practice Address - Street 1:108 SMART PLACE
Practice Address - Street 2:SUITE A
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-649-0002
Practice Address - Fax:985-649-0034
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD021R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACN3640OtherRAILROAD MEDICARE
MS00015683OtherMEDICAID
MSCN3639OtherRAILROAD MEDICARE
LA1318418Medicaid
LACN3638OtherRAILROAD MEDICARE
LA1318418Medicaid
LA56094C213Medicare PIN
LA0533030001Medicare NSC
LACN3640OtherRAILROAD MEDICARE
MSCN3639OtherRAILROAD MEDICARE