Provider Demographics
NPI:1487822946
Name:M. PAUL WATSON, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:M. PAUL WATSON, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:318-388-1662
Mailing Address - Street 1:3510 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2384
Mailing Address - Country:US
Mailing Address - Phone:318-388-1662
Mailing Address - Fax:
Practice Address - Street 1:3510 MEDICAL PARK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2384
Practice Address - Country:US
Practice Address - Phone:318-388-1662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1025178Medicaid