Provider Demographics
NPI:1750363719
Name:WATSON, PETER T (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:T
Last Name:WATSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9701 SW BARNES RD
Mailing Address - Street 2:SUITE 299
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6772
Mailing Address - Country:US
Mailing Address - Phone:503-297-3660
Mailing Address - Fax:503-297-7637
Practice Address - Street 1:9701 SW BARNES RD
Practice Address - Street 2:SUITE 299
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6772
Practice Address - Country:US
Practice Address - Phone:503-297-3660
Practice Address - Fax:503-297-7637
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD11910207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR125179Medicaid
OR125179Medicaid
ORC91064Medicare UPIN