Provider Demographics
NPI:1265703219
Name:WATSON, THOMAS A (CRNA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:WATSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5916 VIA ROBLES LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6614
Mailing Address - Country:US
Mailing Address - Phone:512-496-4096
Mailing Address - Fax:
Practice Address - Street 1:5916 VIA ROBLES LN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6614
Practice Address - Country:US
Practice Address - Phone:512-496-4096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ249356367500000X
TX752137367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered