Provider Demographics
NPI:1295727311
Name:WATSON, FRANK TAYLOR (PD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:TAYLOR
Last Name:WATSON
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 RUTHERFORD ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-4336
Mailing Address - Country:US
Mailing Address - Phone:318-424-7263
Mailing Address - Fax:318-675-4019
Practice Address - Street 1:761 PIERREMONT RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2211
Practice Address - Country:US
Practice Address - Phone:318-861-3666
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist