Provider Demographics
NPI:1598051963
Name:WATSON, JEFFREY WAYNE (CSA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:WAYNE
Last Name:WATSON
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Gender:M
Credentials:CSA
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Mailing Address - Street 1:500 INDEPENDENCE PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5187
Mailing Address - Country:US
Mailing Address - Phone:757-450-9714
Mailing Address - Fax:757-547-9714
Practice Address - Street 1:500 INDEPENDENCE PKWY
Practice Address - Street 2:STE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5187
Practice Address - Country:US
Practice Address - Phone:757-547-9714
Practice Address - Fax:757-547-9714
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical