Provider Demographics
NPI:1811995640
Name:WATSON, WAYNE K (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:K
Last Name:WATSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 K EAST REDD RD, EL PASO TX 9912
Mailing Address - Street 2:PO BOX #226
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912
Mailing Address - Country:US
Mailing Address - Phone:915-581-5555
Mailing Address - Fax:915-581-5775
Practice Address - Street 1:10880 EDGEMERE BLVD # TX79935
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-1306
Practice Address - Country:US
Practice Address - Phone:915-590-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43840207R00000X, 208M00000X
TXF1300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125712305Medicaid
TX8A9677OtherBLUE CROSS BLUE SHIELD
TX8A3401Medicare PIN
TXF92671Medicare UPIN