Provider Demographics
NPI:1265975445
Name:JON THOMAS WATSON MD PA
Entity type:Organization
Organization Name:JON THOMAS WATSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-334-1136
Mailing Address - Street 1:14838 COBO DE BARA CIR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-6908
Mailing Address - Country:US
Mailing Address - Phone:361-949-0994
Mailing Address - Fax:361-334-1574
Practice Address - Street 1:14838 COBO DE BARA CIR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6908
Practice Address - Country:US
Practice Address - Phone:361-949-0994
Practice Address - Fax:361-334-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty