Provider Demographics
NPI:1437251055
Name:WATSON, CHRISTOPHER Z (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:Z
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:
Practice Address - Street 1:405 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:WI
Practice Address - Zip Code:54165-8474
Practice Address - Country:US
Practice Address - Phone:920-833-2318
Practice Address - Fax:920-833-6883
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30467600Medicaid
WI080061777Medicare Oscar/Certification
WI000219Medicare Oscar/Certification
WIB57487Medicare UPIN
WI000108Medicare Oscar/Certification
WI072900064Medicare Oscar/Certification