Provider Demographics
NPI:1790006997
Name:WATSON, KEVIN LEE JR (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:LEE
Last Name:WATSON
Suffix:JR
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 1:215 W BOWERY ST FL 6
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1069
Mailing Address - Country:US
Mailing Address - Phone:330-543-4488
Mailing Address - Fax:330-543-5060
Practice Address - Street 1:215 W BOWERY ST FL 6
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1069
Practice Address - Country:US
Practice Address - Phone:330-543-4488
Practice Address - Fax:330-543-5060
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1211952080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology