Provider Demographics
NPI:1821108036
Name:WATSON, JEFFREY W (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:WATSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 W 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-6102
Mailing Address - Country:US
Mailing Address - Phone:620-343-6011
Mailing Address - Fax:620-343-6353
Practice Address - Street 1:2534 W 15TH AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-6102
Practice Address - Country:US
Practice Address - Phone:620-343-6011
Practice Address - Fax:620-343-6353
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00179213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100094290CMedicaid
KS006713OtherBLUE CROSS BLUE SHIELD OF
KS100094290AMedicaid
KS480000830OtherPALMETTO GBA-RR MEDICARE
KS006713OtherBLUE CROSS BLUE SHIELD OF
KS480000830OtherPALMETTO GBA-RR MEDICARE
KS100094290CMedicaid