Provider Demographics
NPI:1013082247
Name:WATSON, EDWARD JOSEPH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:WATSON
Suffix:JR
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1 JARRETT WHITE RD
Mailing Address - Street 2:DEPARTMENT OF OB-GYN
Mailing Address - City:TRIPLER ARMY MEDICAL CENTER
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:808-433-6621
Mailing Address - Fax:808-433-1552
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:DEPARTMENT OF OB-GYN
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-6621
Practice Address - Fax:808-433-1552
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD5365207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF46465Medicare UPIN
FLK1631Medicare ID - Type UnspecifiedLAST USED 2003