Provider Demographics
NPI:1538297213
Name:JILL L WATSON MD PC
Entity Type:Organization
Organization Name:JILL L WATSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN T
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:405-527-1124
Mailing Address - Street 1:1401 N 4TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-1806
Mailing Address - Country:US
Mailing Address - Phone:405-527-1124
Mailing Address - Fax:405-527-0567
Practice Address - Street 1:1401 N 4TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-1806
Practice Address - Country:US
Practice Address - Phone:405-527-1124
Practice Address - Fax:405-527-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G64669Medicare UPIN