Provider Demographics
NPI:1679891097
Name:WATSON, CAREY LANE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAREY
Middle Name:LANE
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7613 W JEFFERSON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4182
Mailing Address - Country:US
Mailing Address - Phone:260-469-7337
Mailing Address - Fax:260-469-7340
Practice Address - Street 1:7613 W JEFFERSON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4182
Practice Address - Country:US
Practice Address - Phone:260-469-7337
Practice Address - Fax:260-469-7340
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01081997A208600000X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery