Provider Demographics
NPI:1134145931
Name:WATSON, DEBORAH D (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:D
Last Name:WATSON
Suffix:
Gender:F
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:PO BOX 341107
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38184-1107
Mailing Address - Country:US
Mailing Address - Phone:901-366-0080
Mailing Address - Fax:901-366-0070
Practice Address - Street 1:6063 MT. MORIAH ROAD EXTENDED
Practice Address - Street 2:SUITE 13
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115
Practice Address - Country:US
Practice Address - Phone:901-366-0080
Practice Address - Fax:901-366-0070
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3081505Medicaid
TN3081505Medicaid
TN3081508Medicare ID - Type Unspecified