Provider Demographics
NPI:1710949656
Name:WATSON, JEAN B (MD)
Entity Type:Individual
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First Name:JEAN
Middle Name:B
Last Name:WATSON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3433 BROADWAY ST NE
Mailing Address - Street 2:STE 300
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1761
Mailing Address - Country:US
Mailing Address - Phone:763-587-7737
Mailing Address - Fax:763-587-7069
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:250
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3723
Practice Address - Country:US
Practice Address - Phone:612-863-5665
Practice Address - Fax:612-863-4144
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-03-11
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Provider Licenses
StateLicense IDTaxonomies
MN41763207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN128436300Medicaid