Provider Demographics
NPI:1679004386
Name:WATSON, ROBERT DEREK (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEREK
Last Name:WATSON
Suffix:
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 1:5804 B ABCOCK RD
Mailing Address - Street 2:#299
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240
Mailing Address - Country:US
Mailing Address - Phone:210-300-4666
Mailing Address - Fax:
Practice Address - Street 1:17720 CORPORATE WOODS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-3500
Practice Address - Country:US
Practice Address - Phone:210-491-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT22882084P0800X
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program