Provider Demographics
NPI:1922181866
Name:WATSON, TIMOTHY DOYLE (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DOYLE
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 1:1134 MILL ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2813
Mailing Address - Country:US
Mailing Address - Phone:805-807-4875
Mailing Address - Fax:805-439-1828
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-963-8136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2327922085R0202X
CAA961812085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology