Provider Demographics
NPI:1558461418
Name:CENTRAL COAST EAR NOSE AND THROAT ASSOCIATES
Entity Type:Organization
Organization Name:CENTRAL COAST EAR NOSE AND THROAT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-545-5665
Mailing Address - Street 1:PO BOX 13211
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-3211
Mailing Address - Country:US
Mailing Address - Phone:805-545-5665
Mailing Address - Fax:805-544-6477
Practice Address - Street 1:1035 PEACH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2700
Practice Address - Country:US
Practice Address - Phone:805-545-5665
Practice Address - Fax:805-544-6477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42368207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGROO46750Medicaid
CAZZZ25994ZOtherBLUE SHIELD PIN
CA4306521OtherAETNA PIN
CAZZZ25994ZOtherBLUE SHIELD PIN
CAGROO46750Medicaid