Provider Demographics
NPI:1922012129
Name:WATSON, MICHAEL QUEALY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:QUEALY
Last Name:WATSON
Suffix:
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 1:208 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-3448
Mailing Address - Country:US
Mailing Address - Phone:432-758-3267
Mailing Address - Fax:432-758-4970
Practice Address - Street 1:208 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3448
Practice Address - Country:US
Practice Address - Phone:432-758-3267
Practice Address - Fax:432-758-4970
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB62136Medicare UPIN