Provider Demographics
NPI:1962504878
Name:WATSON, PIERCE EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:PIERCE
Middle Name:EUGENE
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 1:4458 ANTELOPE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1559
Mailing Address - Country:US
Mailing Address - Phone:704-599-9087
Mailing Address - Fax:704-599-9087
Practice Address - Street 1:4458 ANTELOPE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1559
Practice Address - Country:US
Practice Address - Phone:704-599-9087
Practice Address - Fax:704-599-9087
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16191207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8985997Medicaid
NC8985997Medicaid
NC2128670Medicare ID - Type Unspecified