Provider Demographics
NPI:1184679821
Name:WATSON, JAMES MARK (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARK
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6478 HIGHWAY 90
Mailing Address - Street 2:STE D
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4560
Mailing Address - Country:US
Mailing Address - Phone:850-564-1030
Mailing Address - Fax:850-564-1039
Practice Address - Street 1:6002 BERRY HILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570
Practice Address - Country:US
Practice Address - Phone:850-626-9942
Practice Address - Fax:850-626-5808
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL786482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259703900Medicaid
FL259703900Medicaid
FLE4131AMedicare ID - Type Unspecified