Provider Demographics
NPI:1841385812
Name:WATSON, JAMES R (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:WATSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 S WW WHITE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-2531
Mailing Address - Country:US
Mailing Address - Phone:210-337-2333
Mailing Address - Fax:210-337-0033
Practice Address - Street 1:1032 S WW WHITE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78220-2531
Practice Address - Country:US
Practice Address - Phone:210-337-2333
Practice Address - Fax:210-337-0033
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00N559OtherBLUE CROSS
TX131609302Medicaid
TX00N559Medicare ID - Type Unspecified
TX131609302Medicaid