Provider Demographics
NPI:1689802225
Name:WATSON, DYLAN JEROME (MD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:JEROME
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 1:35 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4816
Mailing Address - Country:US
Mailing Address - Phone:864-234-7654
Mailing Address - Fax:864-675-1657
Practice Address - Street 1:35 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4816
Practice Address - Country:US
Practice Address - Phone:864-234-7654
Practice Address - Fax:864-675-1657
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31715207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery