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
State | License ID | Taxonomies |
---|---|---|
WI | 23899 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WI | 30467600 | Medicaid | |
WI | 080061777 | Medicare Oscar/Certification | |
WI | 000219 | Medicare Oscar/Certification | |
WI | B57487 | Medicare UPIN | |
WI | 000108 | Medicare Oscar/Certification | |
WI | 072900064 | Medicare Oscar/Certification |