Provider Demographics
NPI:1245429471
Name:WATSON, MICHAEL PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
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 1:1603 TERRAL ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:FARMERVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71241-4012
Mailing Address - Country:US
Mailing Address - Phone:318-368-4393
Mailing Address - Fax:
Practice Address - Street 1:1603 TERRAL ISLAND RD
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241-4012
Practice Address - Country:US
Practice Address - Phone:318-368-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.012676208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB60613Medicare UPIN