Provider Demographics
NPI:1609064351
Name:STEVEN E. WATSON, D.O.
Entity Type:Organization
Organization Name:STEVEN E. WATSON, D.O.
Other - Org Name:STEVEN E. WATSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WILBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-631-9091
Mailing Address - Street 1:6600 S WESTERN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-1700
Mailing Address - Country:US
Mailing Address - Phone:405-631-9091
Mailing Address - Fax:405-631-9990
Practice Address - Street 1:6600 S WESTERN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1700
Practice Address - Country:US
Practice Address - Phone:405-631-9091
Practice Address - Fax:405-631-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD70468Medicare UPIN