Provider Demographics
NPI:1124065792
Name:WATSON, CHARLES MARTIN (PHD, DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MARTIN
Last Name:WATSON
Suffix:
Gender:M
Credentials:PHD, DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 BIG FLAT RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-9210
Mailing Address - Country:US
Mailing Address - Phone:406-728-5190
Mailing Address - Fax:
Practice Address - Street 1:400 S CLARK ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9756
Practice Address - Country:US
Practice Address - Phone:406-723-2781
Practice Address - Fax:406-723-2480
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60225814207R00000X
MT13625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine