Provider Demographics
NPI:1689134900
Name:WATSON, IAN TALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:TALBERT
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-7055
Mailing Address - Country:US
Mailing Address - Phone:858-735-1309
Mailing Address - Fax:
Practice Address - Street 1:605 ENTERPRISE DR STE C
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5405
Practice Address - Country:US
Practice Address - Phone:985-360-3755
Practice Address - Fax:504-962-6111
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA328264207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology