Provider Demographics
NPI:1750319588
Name:WATSON, RAY D (CRNA)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:D
Last Name:WATSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE D430B
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-631-3270
Mailing Address - Fax:251-631-3273
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE D430B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-631-3270
Practice Address - Fax:251-631-3273
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-052920367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051552167Medicaid
AL51510930OtherBCBS
MS04550043Medicaid
R34816Medicare UPIN
AL051552167Medicare PIN
AL51510930OtherBCBS