Provider Demographics
NPI:1609873587
Name:WATSON, FREDERICK D JR (DO)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:D
Last Name:WATSON
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 NORTH LOOP WEST
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092
Mailing Address - Country:US
Mailing Address - Phone:832-553-3572
Mailing Address - Fax:832-553-3402
Practice Address - Street 1:2900 NORTH LOOP WEST
Practice Address - Street 2:SUITE 1300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092
Practice Address - Country:US
Practice Address - Phone:832-553-3572
Practice Address - Fax:832-553-3402
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC00686207Q00000X
NC200400280207Q00000X
TXN0544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00102353OtherRAILROAD MEDICARE
P00115976OtherRAILROAD MEDICARE
SC006861Medicaid
P00102353OtherRAILROAD MEDICARE
SC006861Medicaid
P00115976Medicare PIN
H153037366Medicare PIN
H15303Medicare UPIN