Provider Demographics
NPI:1467464503
Name:WATSON, NATHAN A JR (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:A
Last Name:WATSON
Suffix:JR
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 1126
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-1126
Mailing Address - Country:US
Mailing Address - Phone:972-991-9950
Mailing Address - Fax:
Practice Address - Street 1:1810 W US HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7069
Practice Address - Country:US
Practice Address - Phone:903-821-9688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U3491OtherBLUE CROSS BLUE SHIELD
OK100154550AMedicaid
TX8CD136OtherBLUE CROSS BLUE SHIELD
TX099880905Medicaid
TX8F10227Medicare UPIN
OK100154550AMedicaid
TX099880905Medicaid
TX8F1523Medicare PIN
TXP00724867Medicare PIN